Lord Joffe: My Lords, I beg to move that this Bill be now read a second time. The Bill follows previous Bills of the same nature brought forward in 2003, 2004 and 2005. None was proceeded with in order to allow a Select Committee, chaired by the noble and learned Lord, Lord Mackay of Clashfern, to consider the issues. The committee took evidence over nine months in the United Kingdom, the state of Oregon in the USA, the Netherlands and Switzerland and reported in April last year.
	After the Take Note debate on the Committee's report, I introduced this Bill, which had its First Reading on 9 November last year. The Bill is modelled on the Oregon Death with Dignity Act, which has been in force in Oregon for eight years and has operated satisfactorily with no credible evidence of abuse. I am pleased to be in a position to say that the Bill is supported by a majority of the members of the Select Committee, including two former Ministers of Health. The Bill would allow a doctor, at the persistent and informed request of a terminally ill patient who has capacity and is suffering unbearably, to prescribe medication for self-administration by the patient in order to end his suffering by ending his life.
	To judge from the many letters I have received from opponents of the Bill—some adorned with swastikas, and with many references to the Holocaust—it is clear that there has been much misrepresentation about what the Bill permits and much ignorance about what it does not permit. There appears to be a belief among some of those opposing the Bill that it allows doctors arbitrarily to kill terminally ill patients; that it applies to patients without mental capacity—Alzheimer's being frequently quoted; that the Bill and its supporters are opposed to palliative care; and that it applies to all patients rather than only to terminally ill patients. Nothing could be further from the truth.
	The current law has the following defects. It results in unnecessary suffering by a significant number of terminally ill patients who are denied the right to end their suffering by ending their lives and the right, as they see it, to die with dignity. It is ignored by some caring doctors who, from time to time, moved by compassion, accede to persistent requests by suffering patients to end their lives. That results in grave risks to those doctors' careers, reputations and possibly freedom. It is also ignored by loved ones who face a terrible emotional burden when helping with such a request. It places patients at risk of making spontaneous and ill-formed decisions to end their lives. It influences patients with progressive physical diseases to end their lives earlier than they need to, such as Dr Turner, because they fear that at a later stage they may not be physically able to do that. Finally, it results in patients leaving the United Kingdom to die lonely deaths at Dignitas in Zurich, without any legislative safeguards whatever.
	The Select Committee unanimously concluded in its report that there is a small but significant number of determined patients, generally having strong personalities and a history of being in control, who are unlikely to be deflected from their wish to end their lives by more or better palliative care. As a result of our current laws, these dying patients are forced to suffer therapy against their wishes.
	Under the law as it stands, helping someone to die, even if that person is suffering unbearably from a terminal illness and has asked the doctor to help him to die, is a crime and is punishable under the common law of murder or the Suicide Act 1961 by a mandatory life sentence, for murder, or by up to 14 years' imprisonment for aiding or abetting suicide. However, we know that, despite the law, there is a number of patients whose caring doctors assist them to end their lives. Professor Clive Seal of Brunel University, in a study this year, concluded that such cases may amount to a little more than 900 deaths in England and Wales. In the eyes of the law, those compassionate doctors are murderers.
	In considering whether the law should be changed, regard must be had to a key unanimous finding of the Select Committee that:
	"While the most careful account must be taken of expert evidence, at the end of the day, the acceptability of assisted suicide is an issue for society to decide upon through its legislators in Parliament".
	Let us start with the experts. There is a strong division among them. For example, the Royal College of Physicians was in favour of neutrality when it gave evidence to the committee but later, after a consultation process, decided to oppose the Bill. The British Medical Association was against the Bill when it gave evidence, but subsequently changed to a position of neutrality. The Royal College of Nurses was against the Bill, but a survey in the Nursing Times found 60 per cent of nurses in favour of the law being changed.
	As for society, which is the really important matter, public opinion polls over 25 years consistently show that between 71 per cent and 87 per cent—the latter, incidentally, emerging in a poll in the Daily Telegraph—of society supports assisted dying. Marketing Research Services reviewed the surveys for the Select Committee and concluded that they did not form a very useful guide to public support for legislative change, but recognised an apparent groundswell of public agreement for euthanasia that it felt could not be dismissed. My noble friend Lord Moser, who is widely recognised as a leading expert on such surveys, reviewed the same surveys and will outline his conclusions later in the debate.
	If your Lordships, like me, have been inundated with letters opposing the Bill, you may have thought, "Perhaps public opinion is against the Bill". Public opinion surveys show conclusively that that is not the case. The letters come from some of the relatively small number of deeply committed Christian worshippers and are the result of a massive political campaign by the Churches, led by the Catholic Archbishop of Cardiff, which included the dissemination of 500,000 leaflets or DVDs asking recipients, among other things, to write to Peers and MPs to express their opposition to the Bill. The irony is that research and public opinion surveys, including a 2004 NOP survey, have found that about 80 per cent of Christians of all denominations support assisted dying—a disparity on which right reverend Prelates may wish to comment. It is also a source of comfort when receiving those letters that only 1 or 2 per cent, I should imagine, of the 500,000 have responded.
	The principle underpinning the Bill is one of personal autonomy—the right of each individual to decide for himself or herself how best he or she should lead his or her life. In the NHS, it is called patient choice and is a fundamental principle. It allows patients to request their doctors to desist from further life-sustaining treatment so as to allow them to die, but does not include the right to ask them for assistance to die by prescribing appropriate medication. To many, the distinction between those two cases is invisible.
	Central to the Bill is that it applies only to terminally ill adult patients who have capacity. An informed decision must be made by the patient. Self-administration by the patient is essential. There is a conscientious objection clause for all health professionals. Voluntary euthanasia and mercy killing are not permitted. More than 20 interrelated safeguards ensure that vulnerable members of society are not put at risk.
	The process begins with an adult patient requesting a doctor in writing to assist him to die. As I said, there is then an array of safeguards to be traversed, as set out clearly in the Bill and the Explanatory Notes, including examination by and consultation with two independent doctors, one of whom must be a consultant; a reference, where capacity is in doubt, to a psychiatrist; a consultation with a palliative care specialist; and, finally, if the patient persists, a declaration asking to be assisted to die signed before two witnesses, one of whom must be a solicitor or public notary. Only then, and after a minimum of 14 days have elapsed since the initial written request, may the doctor prescribe the medication, after advising the patient once more of his right to revoke the declaration.
	It is then for the patient to decide when and if to ingest the medication. If he decides to take the medication, the prescribed documentation must be sent to a special monitoring commission set up by the Secretary of State.
	The committee estimated that if the Oregon experience was replicated here, we might expect 650 deaths in England and Wales out of the 500,000 or so annual deaths. The committee also received evidence that many patients do not take the medication, but that it gives them great reassurance to know that it is available in case they require it. The Bill is very different from the legislation in the Netherlands, which is far more widely drafted; allows voluntary euthanasia; and is not restricted to competent and terminally ill adult patients. Accordingly, the evidence of some developments in the Netherlands is of little relevance to the Bill.
	On the recommendations in the Select Committee's report, paragraph 269(b) contains a procedural recommendation that if another Bill of the nature of the previous Bill was introduced, it should, following a formal Second Reading, be sent to a Committee of the Whole House for examination. However, the Bill's opponents have refused to follow this recommendation, which is why we are here today on this sunny Friday. We have carefully considered the remaining recommendations, all but two of which have been incorporated fully or partially into the Bill. Two recommendations are, however, so contrary to the concept of personal autonomy that we cannot accept them: in paragraph 269(c)(v), "unrelievable" or "intractable" suffering is preferred to "unbearable" suffering; and paragraph 269(c)(vi) proposes that the patient must actually experience palliative care before taking a final decision. As these do not relate to the principles of the Bill, we naturally expect to debate them fully in Committee.
	I shall now address some of the concerns raised by the Bill's opponents, all of which are speculation about what might happen, and which can be tested only by reference to the experience of countries where assisted dying is lawful, after making due allowance for differences in culture. It was for this reason that the Select Committee visited Oregon, the Netherlands and Switzerland. I will touch briefly on some of these concerns.
	We naturally respect the deeply held convictions of all those who share a concern about the sanctity of life. The Bill does not seek to interfere in any way with the belief and conduct of those who oppose it, but I question the right of those who object on faith grounds to seek to impose their beliefs on those who do not share them—the overwhelming majority of society. There are two components to the slippery slope argument. One is that, by starting with a small number of deaths, assisted dying will gain momentum until the number has multiplied many times over. In Oregon, out of approximately 30,000 deaths each year, there were only 38 assisted dying deaths in 2002, 42 in 2003, 37 in 2004, and 38 in 2005. Nothing could demonstrate more clearly that there has been no slippery slope in Oregon. As the Bill remains comparable to, but with even more safeguards than, the Oregon legislation, there is no reason to fear that there will be a slippery slope over here. The second component of the slippery slope argument is the fear that the limits of the Bill will be tested in practice so that more and more patients are brought within its remit. This has not happened in eight years in Oregon, and there is no sign of it happening.
	All the committee and all the supporters of the Bill strongly support the provision of more and better palliative care. On our visit to Oregon, it was reassuring to note that palliative care has flourished there since the introduction of assisted dying legislation. The number of patients who use hospices increased from 2,000 in 1988 to 15,000 in 2005 and, according to the evidence that we have received, the expansion was probably accelerated by the legislation, rather than the reverse. There is no reason to believe that palliative care will not significantly increase and improve if the Government provide the necessary funding. Lack of funding, not the introduction of assisted dying, will be the constraint on development. The potential danger of assisted dying to vulnerable members of society has simply not emerged in Oregon. There is no credible evidence of any abuse; Ann Jackson, director of the Oregon Hospice Association, confirmed this to Members of both Houses only last month.
	As for the concern about decreasing trust in doctors, if between 71 per cent and 80 per cent of the public are in favour of assisted dying, it is difficult to follow the argument that they should lose trust in their doctors for doing what they are actually in favour of. A YouGov survey in November 2004 found that 83 per cent of patients would trust their doctors the same or more if there were assisted dying legislation. It will be clear to the House that the coverage of the present Bill is more tightly drawn and restrictive than the earlier Bill considered by the Select Committee, dealing as it does only with assisted dying and explicitly excluding any form of euthanasia, whether voluntary or otherwise. So in some ways it is climbing up the slope rather than descending down it.
	In that context, I shall make my personal position clear. When I gave evidence to the Select Committee about the original Bill, I expressed my personal conviction, which was honestly held at the time, that I would welcome a widening of the scope of the legislation. I no longer hold that view. One of the advantages of the Select Committee process was the opportunity to see different regimes in operation, and to hear a wealth of evidence from those who have thought deeply about the issues and are intimately involved in them. At the end of the process, it is now my firm view that the extent of legislative change that I put before the House today, which we shall now contemplate and should broadly welcome, will have the most advantage and carry the least risk. I would not support further extension into the field of euthanasia, or support assisted dying for patients who are not terminally ill. Others, of course, may have different views, but after three years of legislative effort on the subject, I have no intention of pursuing this issue beyond the ambit of the present Bill.
	As detailed Explanatory Notes have been made available in the Printed Paper Office, and as I have already outlined the key provisions of the Bill, I shall touch only briefly on two specific issues, the first of which is Clause 1(a)(ii), which authorises assisted dying. The great majority of patients will end their lives by orally ingesting the prescribed medication, but provision is made in this paragraph for the small number of patients—we estimate perhaps 5 per cent—who are unable to swallow, such as some motor neurone disease patients, to be provided with the necessary means for them to end their lives. The clause would enable the patient to self-administer by, for example, pouring the medication into their feeding tube. The key point about self-administration, as set out in paragraph 246 of the Select Committee's report, is that responsibility for the ultimate act rests with the patient.
	I give early notice of two amendments to the clause which I propose to move in Committee. These were drawn to my attention by opponents of the Bill, for which I thank them. I now realise that, by including "or appropriate" after "impossible", I have opened up the possibility of the doctor interpreting the provision of means exception too widely, and I intend to seek to delete the words "or appropriate". To set the matter beyond any possible doubt, I also intend to include an explicit prohibition against ending a patient's life by lethal injection or act of euthanasia. I also draw attention to Clause 14(2)(d), which would enable the Secretary of State to provide a code of practice for the guidance of doctors and others acting in accordance with the Act. This code would cover, inter alia, the prescription, dispensing and control of the medication and the provision of the means of self-administration.
	In conclusion, I would underline that the Bill is modelled on the Oregon legislation, which has been operating satisfactorily for eight years. The noble Earl, Lord Arran, who visited Oregon as a member of the Select Committee, will be dealing in detail with the evidence given in Oregon. As a caring society, we cannot sit back and complacently accept that terminally ill patients who are suffering unbearably should simply continue to suffer for the good of society as a whole. We must find a solution to the unbearable suffering of patients whose needs cannot be met by palliative care. The Bill provides that solution, in the absence of any other, and, based on the successful model in Oregon, we can move forward on this sensitive matter with confidence, secure in the knowledge that the Bill would not impose anything on anyone; it merely provides an additional end-of-life option for terminally ill patients, which they are free to accept or reject as they, and only they, decide. I commend the Bill to the House.
	Moved, That the Bill be now read a second time.—(Lord Joffe.)

Lord Carlile of Berriew: My Lords, it is always a pleasure to follow the noble Lord, Lord Joffe, who has made a measured and powerful speech in support of the Second Reading of his Bill. I am sure that the whole House would wish to join with me in wishing the noble Lord many happy returns of the day, it being his birthday. I have to confess that I hope to give him as a present more down time in his life.
	I feel that I should start with a word about procedure, as there has been much misleading material promulgated about the procedure which I propose your Lordships' House should follow today. It has been suggested that dividing the House at the Second Reading of a Private Member's Bill is in some way a breach of conventions of this House, and some have suggested that it is not proper.
	I have of course consulted the House authorities. I have also taken the advice of senior Members of this House with decades more experience here than I. I have had it confirmed to me that what I seek to do today is a proper course. There is no long-established convention that the House does not divide on the Second Reading of Private Members' Bills. In reasonably recent years, it happened once in 1990, twice in 1991, twice in 1992, twice in 1994, four times in 1995, once in 1997 and once in 1998. That it has not happened since 1998 is perhaps a reflection on this House. The frequency of so dividing plainly is influenced by the controversiality of the Private Members' Bills introduced, of which there has been a clear diminution in recent years. The point is that when appropriate this House can, does and, I would respectfully suggest to your Lordships, should divide. The procedure is proper and I hope that we can get on with the real debate.
	The public, it seems to me, wish to vote on this difficult issue, as our postbags show. However, public opinion polls and, indeed, private opinion polls are fragile things. I would urge the House to heed those classic words of advice by Edmund Burke that we, particularly as unelected Members of a House of Parliament, should, like elected Members of the other place, be pillars of what is right and not the weathercocks of perceived public opinion.
	I agree with the noble Lord that some of the letters on both sides of this debate have been intemperate. They are to be regretted. As he said, they are characterised by ignorance. The most insulting of them—as anyone who has spent, as I did, years in the other place will know—are almost always anonymous and, in my practice, thrown straight in the dustbin if people are not prepared to put their name to them—unless they contain a remarkable piece of visual art, which is very rare.
	However, I feel that I should say one further matter about my approach to this debate. Yesterday, on page two of The Times, there was a story suggesting that the noble Lord was saying that three noble Lords opposed to the Bill have broken their word to him that they would not oppose the Bill. By innuendo, there was a clear accusation that I was one such and, in my view, a clear innuendo that the noble Baroness, Lady Finlay, was another. Who the third was suggested to be, I do not know. I have been able to ascertain through conversation with the noble Lord, Lord Joffe, that that story did not emanate from him. It was untrue. It was never checked. It was defamatory. No one broke their word. The Times has apologised generously today. I am pleased to tell your Lordships that whatever else happens in this debate, someone will gain. The Times has generously agreed as a recognition—[Interruption.] I hear a ring tone that goes with the noble Earl's socks.
	I am pleased to tell your Lordships that The Times has generously agreed as a recognition of the defamation that there will be one gainer from this debate at least. The charity, Marie Curie Cancer Care, will receive a substantial four-figure sum from The Times in recognition of the wrongness of what it did yesterday.
	Why should we vote at Second Reading? The noble Lord, Lord Joffe, reintroduced his Bill last year. It went to a Select Committee, chaired, if I may say so with huge respect, brilliantly by the noble and learned Lord, Lord Mackay of Clashfern. There was a substantial report. There was a take note debate in which the concerns of the committee were reflected.
	There will be many more speakers in this debate and I do not want to take up too much time. But, in summary, I say to the noble Lord that his Bill in its revised form, despite a puzzling six months between First Reading and Second Reading—so we are now debating Second Reading towards the end of this Session—does not take fully into account all the concerns expressed by the committee. The noble Lord knows that it has absolutely no chance of becoming law in this Session in the real and practical world in which political people should live. Every word that we in your Lordships' House utter costs public money. It seems to me right that your Lordships' House should not spend further time on a costly but pointless exercise on a Bill that, in my view, cannot be made acceptable by amendment. The only point in giving this Bill a Second Reading is if it can be made acceptable by amendment.
	In answer to something that the noble Lord said earlier, I come to this from an entirely non-religious viewpoint. If I am anything religious I am a monotheist utilitarian, which is not terribly religious, is it? In any event, the religious ethical aspect will doubtless be dealt with by the most reverend Primate the Archbishop of Canterbury and others.
	There are three main points therefore that I want to make briefly. First, despite protestations to the contrary, everyone in your Lordships' House knows that those who are moving this Bill have the clear intention of it leading to voluntary euthanasia. That has always been the aim and it remains the aim now. Despite the small amendments that the noble Lord told us of a few moments ago, the difference between Clause 1(a)(ii) and voluntary euthanasia is but a casuist's smidgen.
	The Bill introduces for the first time into this country the concept of doctors abandoning therapy for deliberately causing a person's death. The fact that a person in law gives the instrument of death to another person who ingests it still includes them as the person causing death. Anyone who, like me, has spent 35 years round the criminal courts would not dare try to make this distinction in front of a judge or a jury in a criminal court.
	I and many others find that, whether religious or not religious, morally objectionable. I include in that moral objection the vast majority of physicians and general practitioners, as their respective royal colleges, the Disability Rights Commission and, as I understand it, the Royal College of Nursing have now said. In my view, they are right. This is morally indefensible legislation. Having visited the Netherlands as part of the committee chaired by the noble and learned Lord, Lord Mackay, I came away even more concerned about what I saw there than before I went. The Netherlands—let us be realistic about this—is a country where euthanasia is used as an alternative to an expensive palliative care system that it does not have. We are told that the Netherlands is now contemplating possibly using euthanasia on babies with learning difficulties who have absolutely no autonomy of their own. In my view, the Netherlands system is very troubling.
	I do not accept that the Oregon system—on which I have read the evidence; I did not go there—is an acceptable system either. We heard on the radio this morning that one of the things that happens in Oregon is that people can opt for euthanasia and then keep lethal drugs, presumably in their refrigerators, to use just in case they feel like it at some time in the future. What kind of a system is that?
	So I find the system as proposed morally indefensible, but in any event we do not need it in this country. The tireless noble Baroness, Lady Finlay of Llandaff, who, I am delighted to say, is soon to become president of the Royal Society of Medicine—

Lord Carlile of Berriew: —is a leader in the palliative care field. I am sure she would accept that there is always room for more resources, but the fact is that we have developed a palliative care system which is capable of meeting every need discussed in these debates, with relatively few more resources in global terms.
	My second objection is that this Bill and what is proposed is a legal minefield. It holds a great deal of promise for my learned friends in their struggle against falling fees in publicly funded cases. But so porous are the provisions in this Bill that I suggest to your Lordships that we would become more likely than now to see physicians, lawyers—because there are provisions here to involve lawyers—and, perhaps above all, relatives of the sick before the courts on criminal charges.
	My third objection is that the Bill provides a complete ethical nightmare. The chorus of doctors who object to this legislation speak of that ethical nightmare, and it causes real fear among very old people, many with disabilities and those with other serious illnesses because they cannot begin to understand—and nor can I—how ethical provisions could cover this matter. I shall quote briefly from a letter from a Mr Peter Hobbs, who lives in the Reading area, speaking of his Caroline:
	"I have a real concern that those whose moods are altered by their treatment, as Caroline's was, could, instead of receiving treatment to alleviate depression, simply be allowed to drift into a state where they decide to take their own lives".
	No ethical guideline devisable by humankind could deal with that problem.
	I spent 10 years between 1989 and 1999 as an active lay member of the General Medical Council. Both on the Conduct Committee and the Health Committee I witnessed many times the problems even straightforward events can cause in ethical terms. I witnessed ethical problems arising from everyday elective surgery, a good example of which would be cosmetic surgery conducted as a matter of the patient's choice. That was an ethical challenge and it involved what at least some would say is mere alteration of the contours of a part of the body. This is an ethical challenge on a completely different moral and philosophical plane and I do not believe it is a challenge that any of us could meet.
	I look forward to many interesting speeches in the debate; having to be short concentrates the mind wonderfully, doesn't it? I invite noble Lords to pay special attention to the speeches of the most reverend Primate who, if I may put it this way, formed one third of a unique letter to The Times this morning. I believe that it was the first time there has ever been a letter signed by the leaders of three very large religious communities on a piece of legislation. I also invite the House to take special note of the speech of the noble and learned Lord, Lord Mackay of Clashfern, who is to speak late in the debate. He has been extremely careful in the way he has treated this issue, and I think he may have some powerful things to say to the House later. I beg to move.
	Moved, as an amendment to the Motion that the Bill be now read a second time, to leave out "now" and at end insert "this day six months".—(Lord Carlile of Berriew.)

Baroness Jay of Paddington: My Lords, I congratulate the noble Lord, Lord Joffe, on introducing once again a very important Bill on a fundamentally important issue. As a member of the Select Committee and, indeed, of the Select Committee in your Lordships' House of 10 years ago, I am very pleased that he has now decided to follow the experience of the state of Oregon in its Death with Dignity Act. Those of us who had a chance to visit Oregon and to look at its procedures on the ground were impressed by what we saw.
	Perhaps I may say that until now I think we have followed an exemplary parliamentary procedure on this complex question. The original Private Member's Bill was considered in a very extensive Second Reading. A special committee of the House was then appointed. It took vast amounts of evidence, both in this country and abroad, which led to a unanimous report published just before last year's general election. It is important to note that, because of the timing of that publication, the report recommended that if a new Bill was introduced in this Parliament it should receive the customary Second Reading. I heard what the noble Lord, Lord Carlile, said about procedure and no Bills being taken to a Division on their Second Reading since 1997. I believe the one that was taken to a Division in the 1997–98 Session was on the welfare of pigs; I suggest that the Bill before us is probably more important. There have been some 105 such Bills since 1997–98 and, again, as is customary, this Bill should be referred to a Committee of the whole House. The noble Lord, Lord Carlile, said that there was a great deal of ignorance and confusion about this issue. I suspect that some of that could well be eliminated in the way suggested by the noble Lord, Lord Joffe, in his opening remarks if we could deal with some of the substantive detailed questions in Committee. I hope very much that that will be the basis on which we can proceed.
	I am surprised that the noble Lord, Lord Carlile, who is, as he explained, a member of the committee, has tabled this amendment today. I mean absolutely no disrespect to the noble Lord because I know how busily he is engaged in many matters of enormous importance to this country, but he was unable to attend the great majority of the meetings of the committee and, indeed, did not visit Oregon with those who did and who were so impressed by the system there. I hope therefore that he will respect the collective view of the committee that a Bill of this nature which comes before us should be properly considered and not wrecked at Second Reading, as his amendment would achieve.
	I remind noble Lords of the other remarks of the noble Lord, Lord Joffe, on the responsibility of legislators in Parliament. Obviously, we will have a considerable discussion on what society may think about this issue and what it is that is reflected in public opinion polls, but I would emphasise that the democratic accountability of Parliament, whether in this unelected Chamber or in the other place, is a relevant matter which should be considered above the force of special interest groups, however many letters those groups may get together to write. I say that too with great respect and concern for the views of the right reverend Prelates and the most reverend Primate who are to speak in the debate. However much we may respect the opposition in principle to this Bill from those with religious faith and those of us who have a spiritual concern that perhaps may not be a formal religious faith, we live today in a diverse and predominantly secular society where the importance of individual human rights is increasingly valued. The Minister, my noble friend Lord Warner, made the point when winding up our previous debate. He also emphasised on that occasion that patient choice is a central theme in today's healthcare.
	The Select Committee heard a consistent message about patient choice. From the evidence we received we simply have to recognise that there are some people who, if they were terminally ill, would prefer to end their lives in a controlled and dignified manner rather than continue to receive care until a so-called natural death. To accept this evidence in no way undermines the importance of palliative care, which plays an enormously important role in modern medicine. This Government have rightly pledged to double their investment in palliative care. No doubt, as in so many areas, change could move further and faster, but as an advocate for these services in the voluntary sector, in the hospice movement and in the NHS over the past 30 years, I am encouraged by recent progress.
	There is no dichotomy between my support for extending palliative care and my support for the Bill before us today.  I can only repeat that the vast majority of terminally ill patients can be helped by palliative care; for the minority, they may experience either intractable suffering or simply prefer to end their lives. At no stage in any of the debates we have had—or, indeed, in any of the testimony to the Select Committee—did we hear those who promote palliative care as a universal panacea produce a convincing answer for that minority.

Lord St John of Fawsley: My Lords, I congratulate the noble Lord, Lord Joffe, on introducing the Bill. It requires great courage to introduce a Bill of this kind, and he has shown it. If you do not have courage in politics, there is no assurance of achieving anything. I also congratulate him on his record on human rights and the work he has done in that area. If the noble Lord has received some abusive letters, it is a bore but it is a part of the small change of public life. You do not have to read a letter very far before you find that it is abusive—normally it starts before the "dear"—so throw it in the wastepaper basket and forget about it.
	The noble Lord, Lord Joffe, has achieved something very important: he has shown the relevance of this House to our social and moral issues. This House is the forum where these great issues can be intelligently and temperately discussed. We have no other institution where this can happen. It is one of the great glories of this House that this should happen here, where there is so much expertise, knowledge, experience and real concern. I am delighted that that is so.
	There is tremendous interest in this topic simply because the life of a great society depends on a common possession of moral principles. If those moral principles disappear, the society disappears with them. People are so concerned about this issue because, at a time of great moral change and uncertainty, one of the fundamental pillars of our society is being shaken. And now I leave issues of moral principle to the Bishops. I find it difficult to do so, but we all have to make sacrifices.
	The first major practical point I wish to make concerns abuse. The deadly sin of our time is not sexual promiscuity, which the Church goes on about the whole time—too much, in my opinion—and provides a mirror image of the ills of society; the evil of our time is greed, which exists throughout society and at every level. The trouble is that the Bill would open the way to abuse by the greedy and the acquisitive and bring pressure on those who are at their most vulnerable.
	My second point is that the end of life, the last period of life, is not a wasteland necessarily. It can be a wonderful period of renewal, reconciliation and acceptance. I have never spoken about this personal experience in public, but I do so now because I feel the issue before us is so important. My dear mother died in a convent here in London. I was summoned from a Shadow Cabinet meeting to her bedside. She said to me, "I do not want to die, but I feel that I am a burden to you". I said, "Dearest, you could never be a burden; you are an inspiration to me". I said, "If you do not want to die, let us say so out loud the Lord's Prayer, the Hail Mary and the Prayer of the Trinity"—because vocal prayer is sometimes so powerful. "Our prayer is that, if it is the will of God, you will rise through this crisis". We prayed and she fell into a deep sleep—and from that moment the fear of death lifted. As it lifted from her, I felt what it was like. It was like being up against a brick wall, but you could not get over the wall and you could not move backwards from it. It was one of the most dreadful experiences I have ever had.
	A year later she died. The marvellous reverend mother in charge, Mother Serrano, said to her, "Offer up everything you feel with the Lord". She said "Yes", bowed her head and died. Deo gratias for all those who substituted for a snuffing-out tender, loving, practical care and reached such a splendid result.

Baroness Finlay of Llandaff: My Lords, why does this Bill ignore the majority of the essential changes recommended by the Select Committee report when we as a Select Committee looked at the previous Bill? Several so-called safeguards have been weakened, despite the committee recommending that they needed to be tightened up.
	The Bill is not called "Assisted Suicide" for good reason, because it takes us to the very brink of euthanasia in one fell swoop. Doctors could supply a lethal overdose, which is assisted suicide in the Oregon law. But what are the alternate means, undefined in this Bill, by which those drugs could be taken? The doctor is not required to be present, so who knows whether the patient actually took the drugs themselves or was euphemistically "helped" by someone else? How could malpractice be proven if the principal witnesses were dead or would not come forward?
	The Bill ignores the recommendation that the doctor's actions be clearly set out. As I listen today, there is still no clarity about precisely what "assisting to die" is. Even the proposed amendment does not clarify what alternative means to ingest can be provided, nor the circumstances in which an intravenous dose could be used.
	The Bill flies in the face of the committee's recommendation that,
	"a clear distinction should be drawn in any future bill between assisted suicide and voluntary euthanasia".
	The test for mental competence is weakened. The applicant should not "lack capacity", yet the Mental Capacity Act was designed for different purposes and errs towards preserving life, not committing suicide. The Bill has dropped protecting those whose judgment is impaired through fear, misinformation or depression, despite the committee's recommendation that all applicants should have a psychiatric assessment. Dutch research shows that undiagnosed depression is eightfold more common in those seeking assisted dying than in those who do not.
	No clinician can accurately predict prognosis beyond eight to 12 weeks at most. The committee recommended that a definition of terminal illness should "reflect the realities of clinical practice", but it has been slackened to cover anyone considered to have six months to live. Now any progressive disease that cannot be reversed by treatment is included, rather than just those whose effects cannot be reversed. How does the doctor judge that you are or are not suffering enough, if you refuse attempts for your "unbearable suffering" to be relieved?
	I am Professor of Palliative Medicine at Cardiff University and Groningen University in the Netherlands. There are failures and complications, even when doctors assist suicide or inject a lethal overdose. The public need to know that 94 per cent of palliative medicine specialists in the UK oppose this Bill. It is we who work day in, day out to give dignity to the dying; know the pressures and fears behind the statement, "I wish I were dead"; and know how often time and care that enhances dignity prove everyone wrong. Across all hospital doctors, over 71 per cent oppose this Bill, a figure proven by validation using the very question put to the profession by the noble Lord, Lord Joffe.
	Palliative care in Oregon does not fulfil the quality specialist criteria of the UK. It is domiciliary primary care or in-patient care at the end of life. I was not impressed by what I saw when I went to Oregon as a member of the Select Committee. Our palliative care has led the world, and the world is watching this debate. In letting this Bill proceed, we would be giving a message to the rest of the world that we will abandon the vulnerable and treat suffering by ending the sufferer's life. Let us get on with working for patients to live as well as possible until a natural dignified death and teaching others how to do it, not be taken up in becoming complicit in suicide.

Baroness David: My Lords, I speak to support the Bill of the noble Lord, Lord Joffe, and to speak against the, in my view, ill-judged amendment of the noble Lord, Lord Carlile. I still hope that he may withdraw it.
	All the Bill provides for is an option. The safeguards are very strong. In a review of the safeguards and qualifying conditions, Professor MacLean says that the Bill offers far more protection that the current situation, both for those who want this option and those who do not. I have one reservation about Clause 3 on determination of lack of capacity. Here, if, in the opinion of either the attending or consulting physician, a patient who wishes to make a declaration may lack capacity, the attending physician shall refer the patient to a consultant psychiatrist or psychologist, who shall be independent of the attending physician, for an opinion on the patient's capacity. I think I should resent that, and I wish it were not in the Bill.
	I strongly believe in personal autonomy and the right of individuals to decide when and how they die. As a 92 year-old, and I think probably the oldest person speaking in this debate today, I think it is patronising for opponents of the Bill to suggest that elderly people are unable to make informed decisions about their lives. If I were terminally ill, I believe that I would be the only person with the right to decide how I died and whether I preferred palliative care to assisted dying. It would provide me with an additional option on how to end my life, which I would find tremendously reassuring, whichever choice I made. With all the hurdles to get over before it is possible to decide on the assisted dying option, I hope I would have the courage and determination to make that choice. I think I should.

Baroness Hayman: My Lords, the noble Lord, Lord Carlile, opened his speech by objecting, quite rightly, to the misrepresentation of his position in The Times recently. Perhaps I could open mine by objecting to what I felt was a misrepresentation of my position when the noble Lord said that those who supported the Bill and were proponents of it were intent on extending it to euthanasia in the future.
	I went on to the Select Committee as someone who did not have clear views on this subject and was not committed to the Bill that had been brought forward formally. It was only following my experience on the committee and having listened to the evidence that I felt that I could, with good conscience, support a Bill that was constrained to physician-assisted suicide but would not be able to support a Bill that allowed physician-administered euthanasia. I made that position clear in your Lordships' House and when I spoke in the Select Committee, and I certainly made it clear to my noble friend Lord Joffe.
	I feel that it is unfair to punish my noble friend Lord Joffe for having constrained the Bill. He listened to some, like me, who felt that it should be more limited and then brought forward a more limited Bill. So it is unfair then to argue in procedural terms that, because the Bill is more limited, we are not bound by the recommendation in the Select Committee report that this should go on to further and full discussion in your Lordships' House. It would be a matter of enormous sadness to me if we could not deal with these issues in some detail.
	I wish to say something to two fellow members of the committee. First, I say to my noble friend Lord Turnberg that his register against which to assess this Bill is exactly the same as mine but he comes to a different conclusion on whether you can meet the needs of a minority without endangering a majority. We differ not on our absolutes but on our interpretation of the Bill. Secondly, I say to the right reverend Prelate the Bishop of St Albans, whose company I enjoyed enormously—we swapped a lot of books during our time on the Select Committee—that I, too, felt as though I was living in the world of Alice in Wonderland when I read the letters that I received recently about the Bill, because they described a Bill quite different from the one before the House today. So it is possible for us to have the same feelings but to disagree about the way forward.
	Finally, I absolutely agree with the noble Baroness, Lady Williams, that at the end of life we need to show people love and respect as well as giving them physical and medical care. For some people—I say this having received testimony both as part of the committee and personally from individuals—that love and respect would be given and devoted by the implementation of the Bill introduced by my noble friend Lord Joffe. The question whether we can afford that quality of love and respect for a minority without causing anxiety and detriment to many others is a matter of the gravest concern to us as legislators. It is not a question to which we can answer "yes" or "no" today; it deserves the most detailed attention and I hope that, for that reason, the House will not support the amendment of the noble Lord, Lord Carlile.

Lord Ballyedmond: My Lords, to speak on this Bill is to undertake the position of being heard as yet another voice with yet another amalgam of personal opinions on this multifaceted issue. I do not seek to preach morals and ethics, nor do I seek to persuade others to adopt my opinion on these issues. Instead I wish to establish facts.
	There has been some debate among doctors regarding the appropriate stance that they should take as a profession in the spotlight. Their position of neutrality in the past was borne out of a desire to remain as the providers of medicine rather than to become the keepers of society's ethics and morals. Nor do they wish to become law makers. There is now a definite opinion in the medical profession after a Royal College of Physicians survey showed that three-quarters of the profession oppose a change in law. These doctors believe that a change in legislation is not necessary for the small number of patients whose needs are not met by current levels of palliative care, where that palliative care is not sufficient or is believed to be insufficient. It is our duty to pay due attention to the body of professionals to which this Bill is directed. Regardless of one's personal views on this matter, it must be noted that, before the Bill of the noble Lord, Lord Joffe, could ever be implemented, a wealth of research and development in the field of palliative care would be required. That has not yet occurred to a satisfactory level.
	We are elevating ourselves to a very high platform today. We are adjudicating on a Bill to legalise the taking of life. My view is that to legalise assisted suicide is an attempt to regulate death and to remove the very aspects that in life we fight to protect. Rightfully, there can be no such legislation. We must exercise caution and treat voluntary death with the respect that it commands. This is not an issue that can be resolved on the basis of who is right and who is wrong. We must be very careful not to give any further credence to the Bill, which may ultimately be abused to the point where the sick, dying and disabled in our society will be placed in an unacceptable position. This Bill contains unsatisfactory safeguards.
	We do not have the benefit of sufficient proven scientific evidence at our disposal today to make the decision to support the Bill or accurately to assess its consequences. To proceed where experts do not wish to go would, in my view, be the utmost folly. I ask your Lordships to reject the Bill in its totality. To do otherwise would mean that we were crossing the Rubicon. The die must not be cast.

Viscount Craigavon: My Lords, on the last two occasions when this subject was debated, I fully supported the noble Lord, Lord Joffe, and I continue to do so. Even more so now do I believe in the desirability of further examination at Committee stage of what is proposed. As the noble Lord, Lord St. John of Fawsley, said, your Lordships' House is an ideal forum for such examination.
	Owing to the time pressures of this debate, the noble Baroness, Lady Finlay of Llandaff, came up with a string of assertions of what she believed were the defects of this Bill. It would be ideal if all her points could be examined and debated in Committee. If we come to that point at the end of today by passing the Motion of the noble Lord, Lord Joffe, to commit the Bill to a Committee of the Whole House, I sincerely hope that any opposition will be entirely constructive.
	I believe that, as many noble Lords have said, we should be taking more account of public opinion. However much some inconvenient opinion polls are discounted, it seems to me to be clear that a convincing majority of the public are in favour of some change in the law. My justification for that view are the figures that I used in our previous debate and those that the noble Lord, Lord Joffe, quoted today.
	I have wanted to ask many speakers who have opposed the Bill today this question: are you content that we should have a continuing procession of cases to Zurich in Switzerland involving people who do not accept the present orthodoxy offered by the Churches and by the noble Baroness, Lady Finlay?
	I recommend that anyone who is trying in future to understand this stage of our debate should listen to a recording of what some of your Lordships may have heard on Radio 4 just after eight o'clock this morning. It was a perfect vignette of our arguments. A distressing case was articulately presented by a woman called Sally McIntosh, who would have liked to have been able to avail herself of what the Bill would allow. However, she said that she had only a few weeks to live and could not get the paperwork required by Swiss rules ready in time.
	That was followed by the two Archbishops, who had absolutely nothing to offer that individual. They went on, in the expected form of words, to question the concept of autonomy and to argue that, because it is impossible to get the law into a perfect state, everything should remain unchanged. That woman had consciously and with rational consideration rejected palliative care, but that strategy is not allowed by the Churches or by the noble Baroness, Lady Finlay. Because of what I call their absolute position, whatever distressing circumstances you might describe, you are told that you have not thought it through properly. My noble friend Lady Finlay told us in her speech that when she hears the words, "I wish I were dead", she needs to interpret them for you—on the grounds that you do not really mean what you say. And I imagine that if you are not convinced by her first interpretation, she will explain again, and so on. I am not just personalising this on her: that is now the attitude of the Churches, and I would personally call it "Kafka-esque". That is the intractable difficulty of the position where no exceptions are allowed in the debate.
	In my view, the discussions around autonomy have become a self-induced fog, to obfuscate the debate and to cause apparent uncertainty. It sometimes seems like a medieval disputation that, almost by definition, has no solution hence no conclusion can be arrived at. Similarly, it sometimes appears that because perfection cannot be reached in framing a law in this apparently very difficult area, nothing should ever be done. In my opinion, those have become largely excuses. We get the phenomenon of "society" being defined in such a way that it can never, by definition, allow enough autonomy ever to permit a decision for people to be allowed to avail themselves of the option under this Bill. I believe that those amount to excuses for perpetual inaction. We should be more practical.

Lord Laing of Dunphail: My Lords, in supporting the Bill, I acknowledge the risks. But let us not overstate them to the extent that the benefits are submerged. We must keep our eyes firmly on the intention behind the Bill, which is to achieve the legal framework for competent, terminally ill adults to die with dignity at a time of their own choosing and in the controlled manner that they desperately seek. In our heart of hearts, is that not what we would all pray for and hope for?
	While containment of pain is obviously important, I base my arguments on quality of life. The briefest examination of the evidence from Oregon reveals that this particular group of patients are not motivated by pain, but by their own judgments and the quality of their lives. Why on earth should we refuse to grant a competent adult their request to receive assistance in dying when suffering unbearably from an illness such as motor neurone disease?
	Is it not a form of arrogance to deny someone such as I have described the right to take their onward journey with dignity and in their own time? Which of us has the right to say, "No, you can't"? If someone who is near the end of their life feels that their life is without value, why should we force them to live against their will?
	As a Christian, I believe in life after death. Remember the words of Christ uttered on the Cross to the two thieves:
	"Today, you will be with me in Paradise".
	If the words of Christ are as meaningful as they are to me, the next life will be a happier place. I see no contradiction between my faith and my support for the Bill.
	A person contemplating assisted suicide will no doubt bear in mind the views of the Church. But I believe that one has a personal relationship with God through Jesus Christ. If after prayer one chooses assisted suicide, that is a personal decision between oneself and one's maker. We should bear in mind that God gave us free will.
	It is a strange coincidence that we are debating this issue almost four years to the day that brave Dianne Pretty died. I, like the majority of the population at the time, did not believe that she should have had to suffer the indignity of dying in the manner she feared; a manner contrary to all her values. Since then, many others have been forced to go on living against their will and I hope that this House will have the compassion to spare others the same fate.

Lord Mawhinney: My Lords, I pay tribute to the noble Baroness for her speech.
	My mailbag experience was the same as that of the noble Baroness, Lady Williams of Crosby. Overwhelmingly, it consisted of letters against the Bill. Knowledge from another place suggests that when those letters are being written off a factsheet, you can see the similarities between them. The letters that I received were personal experiences. Two views emerged. One was that the passage of the Bill would alter the value of human life. The most reverend Primate made the point that not only would it alter the lives of those who might make a decision, it would alter the lives of a lot of others who might want to resist making such a decision. Secondly, it would alter the relationship between members of the medical profession and their patients. Over and over, doctors wrote to say: "We were trained to heal and save life, not to kill".
	Because of time pressure, I shall read only one paragraph from one letter. It is from a nurse in Cheshire. She wrote:
	"As a senior nurse working in Intensive Care, I care for the sickest patients often undergoing degrees of pain and suffering with a plethora of problems. Sometimes these problems seem insurmountable and I will admit I have thought that they may be better off dead. With care and support provided by skilled and caring staff they can be helped through their ordeal. I have realised how wrong I was when patients return to visit the unit, grateful to be alive".
	That is not a deeply theological argument; it is an intensely practical and pertinent day-by-day argument that applies to the Bill.
	I was grateful to the noble Lord, Lord Carlile, for pointing out the illusory difference between killing and simply writing the prescription that makes the killing appropriate. He was absolutely right to do so. I hope that the House will not think the less of me if I say that I was reminded of all the safeguards that were built into the abortion legislation to facilitate its passage on to the statute book. Of course, I imply no such motivation to the noble Lord, Lord Joffe, in this case, but I am persuaded by previous experience.
	In his speech, the noble Lord, Lord Joffe, said that he hoped that those of us whose views were shaped by faith would not press our faith because it is a minority view in a secular society. I can tell the House that I have spent 27 years in public service and I do not believe that I could ever have been accused of using my faith as a cudgel. I seek to have my faith integrated as part of who I am. I cannot—and I will not—seek to dissociate who I am and my views from my faith. My faith and my world view are just as legitimate as the faith, whether secular or theological, and world worth view of anyone else.
	Finally, I believe the noble Lord, Lord Joffe, was quoted over the weekend as saying that he had received hate mail. As a former Minister, I know what that is like. I deplore it, and he has my sympathy. It was also said that he had said that much of the mail he received lacked Christian compassion. I recognise his compassion and I dissociate myself from any letters he received that lacked Christian compassion. Equally, I hope that he will recognise my compassion. This is not a battle about compassion; it is a question of judgment. I simply do not share the noble Lord's judgment.

Lord Haskel: My Lords, I congratulate the noble Lord, Lord Joffe, on the careful, dignified, courageous and determined way in which he has promoted his Bill. He and his colleagues travelled far and wide to take evidence so that all of us could become wiser and better informed, and I thank him and the members of the committee for their hard work. I want to make three points, in the main gently to remind noble Lords about our role as parliamentarians.
	First, we are here to serve the public as a whole. We legislate to enhance and preserve people's rights and freedoms. Let us remember that Parliament was equally divided not only over abortion and homosexuality, but on cloning and assisted fertility. But in the end Parliament produced careful regulations to safeguard and control these activities which respect people's concerns and beliefs while preserving their freedom of choice. I think we must do the same here.
	Secondly, I turn to the slippery slope argument. This House delayed the abolition of capital punishment for years using that argument, one which claimed that abolition would turn this country into a murderers' paradise. It was wrong then and, when applied to this Bill, it is probably wrong now. I think we should learn the lesson.
	Thirdly, like it or not, this issue has become a matter of great public concern and controversy. Noble Lords have all spoken of the number of letters they have received and the many broadcasts about it. The Motion put by the noble Lord, Lord Carlile, to kick it into the long grass would, I fear, expose us to criticism and perhaps ridicule. People would ask: what are we here for? The noble Lord, Lord Carlile, said that he sees no way of amending the Bill to make it acceptable. Well, that may be his opinion, but fortunately we have procedures to see whether a way can be found to make a Bill acceptable by amendment, by compromise and by scrutiny. That is why I hope your Lordships will allow this Bill to continue its passage.

Baroness Cumberlege: My Lords, I should like to begin with a quote from Woody Allen, who said:
	"I am not afraid to die. I just don't want to be there when it happens".
	I share that view because dying is not for wimps. In the opening lines of her very charming novel, Miss Garnet's Angel, Salley Vickers wrote:
	"Death is outside of life, but it alters it. It leaves a hole in the fabric of things which those who are left behind try to repair".
	Friends, families, doctors, nurses and bereavement counsellors know that all too well.
	Is it surprising, therefore, that doctors in palliative medicine, the very ones who are charged to participate in assisted suicide, are overwhelmingly against this Bill? They know that the way in which we die influences the difficult job of repair. According to the most recent survey, 94 per cent do not want legislation and only 3 per cent are prepared to be involved. Furthermore, young doctors, those training in this specialty, are totally against the Bill. Their representative is on record as saying:
	"I am not aware of a single trainee who supports Lord Joffe's Bill".
	But what about those attending and the consulting physicians, those who are also required to be complicit? Well, not much enthusiasm is to be found there either. The Royal College of Physicians, using the question framed by the noble Lord, Lord Joffe, asked its members and fellows:
	"Do you believe that a change in legislation is necessary for the small number of terminally ill patients for whom palliative care does not meet their needs?".
	That question received a resounding answer: "No". This week the Royal College of General Practitioners issued a statement that the college is also opposed to any change in legislation, as has the Royal College of Psychiatrists. The most recent statement from the Royal College of Nursing is unequivocal:
	"The Bill fails to provide sufficient safeguards. It is unworkable and it should be defeated".
	These are the very people who value and cherish their professionalism, who understand that the most precious element they possess is the trust between their profession, the patient and the public. They recognise how this Bill erodes and corrodes the central tenet on which their very professionalism depends. We should value their commitment and support them in defeating this legislation.
	I want to respond briefly to the noble Viscount, Lord Craigavon. I am very disappointed that he should have so misunderstood the fine speech made by the noble Baroness, Lady Finlay. I would urge him to do as I did and visit her and her inspirational service in Cardiff. I am sure he would then gain insight and a better understanding not only of the noble Baroness but of the hospice movement as a whole.
	Finally, I understand that in Switzerland at the Lausanne university teaching hospital, assisted suicide is now freely on offer to patients. I wonder what that does to young doctors, to those who enter the profession to treat and cure and who are now required to learn how to kill. What does that do to the confidence of patients, of whom some in this country are already fearful of being admitted to hospital due to MRSA and hospital-acquired infections. When they are at their most vulnerable and in strange surroundings, is it not possible that they may indeed feel they have a duty to die, not least to save the expense of keeping them alive? I support the amendment.

Baroness Thomas of Walliswood: My Lords, I speak as one who supports the Bill brought forward by the noble Lord, Lord Joffe. The evidence we read and heard as members of the Select Committee gave me added confidence in that opinion. The things I would have said in defence of the Bill today have been put quite brilliantly by the noble Lords, Lord Ashley of Stoke, Lord Beaumont of Whitley, Lord Gilmour of Craigmillar, the noble Earl, Lord Arran, my noble friend Lord Goodhart, the noble Baronesses, Lady Jay of Paddington, Lady Murphy, Lady Hayman, Lady David, and many others.
	Were the Bill to get to a Committee of the whole House, which I devoutly hope it will and which was the unanimous recommendation of the members of the Select Committee, I might want to table amendments to it. In particular, the Bill does not include any reference to the role of nurses in the care of the dying and in that of their friends and families. I understand that reference to this role may be difficult to include in the Bill, bearing in mind that the sole responsibility for responding to a patient's request is laid upon the doctor. But we would need to ensure at the very least that nurses could not be implicated against their will or by mistake.
	I want to add only that we live in a secular society within which individuals may express their own belief in the way they live their individual lives. Nothing in the Bill could force anyone who objects to it on religious or philosophical grounds to avail themselves of its provisions, any more than the existence of laws permitting divorce can force a couple to divorce if they feel that their religious beliefs forbid them to do so. I share the dismay expressed by my noble friend Lord Taverne regarding the so-called Christian campaigns against the Bill. But in any case, this issue is surely one for society as a whole to determine, not doctors or divines acting on our behalf.
	I turn now to the amendment. I am saddened by my noble friend's decision to put down an amendment to kill the Bill. First, it seems to run contrary to the longstanding traditions of free speech embraced by capital-l Liberals and little-l liberals alike. Secondly, it prevents this House doing what it does best: giving intense and detailed attention to the minutiae of legislation so as to test its real scope and consequences, whether intended or unintended. Thirdly, this Bill and the whole issue of the rights and wrongs of personal control of end-of-life decisions are of intense interest to the public. Indeed, as the noble Lord, Lord Joffe, reminded us, over a number of years there has been a substantial majority in favour of the sort of proposals being put forward in this Bill. This House, more than any other institution I can think of, is ideally suited through its composition and methods of working to render a real service to the people of this country, not by refusing to consider the Bill in detail, but by insisting on so doing.
	So I hope that my noble friend will not put his amendment to the vote. But if he does so, I urge noble Lords, and especially those who do not like the Bill, to reject the amendment.

Baroness Emerton: My Lords, the Bill, like its predecessor, would allow physician-assisted suicide for someone who is,
	"suffering unbearably as a result of terminal illness".
	This is undoubtedly one of the most problematic of the conditions of the Bill. Who is to say what constitutes "unbearable suffering"? As the noble Lord, Lord Joffe, said in his evidence to the Select Committee, it is what the patient says is unbearable. It is defined as,
	"suffering, whether by reason of pain, distress or otherwise, which the patient finds so severe as to be unacceptable".
	This is no objective test, no safeguard. By what criteria can a doctor say that the patient is not suffering enough?
	The Bill states that the "unbearable suffering" must be as a result of terminal illness, yet so often the greatest suffering derives from unresolved issues and conflicts which resurface during a terminal illness and compound physical symptoms. The Bill does not require any efforts to have been made to relieve the suffering. No wonder the Select Committee firmly recommended that a better safeguard would be "unrelievable" or "intractable" suffering.
	But, as has already been mentioned, can we think about the staff—the nurses, doctors and healthcare professionals who provide care? What are they to do in the face of a patient who is seeking physician-assisted suicide and who is obviously suffering? Do they continue to strive to improve the quality of life with the clock ticking, when all their efforts will be abandoned in favour of death? Indeed, how can they address the emotional, social and spiritual aspects of suffering when all the time knowing that, if they are successful in relieving the suffering, the patient will then become ineligible for the very thing that he or she seeks—namely, assisted suicide? Professionals in Belgium describe that it is harder to give good palliative care now that their law has changed precisely for this reason. This criterion as a safeguard is unworkable.
	I am privileged to have spent my career as a professional nurse, and as a practising Christian I believe in the sanctity of life. I am a member of the Royal College of Nursing, which represents 380,000 nurses. It has recorded its official view that the college members oppose the Bill. I, too, oppose the Bill.

Lord Young of Norwood Green: My Lords, I commend the noble Lord, Lord Joffe, for his courage and persistence and offer my support for his Bill. I trust that your Lordships will not accede to the invitation of the noble Lord, Lord Carlile, to apply euthanasia to the Bill, because it is in the tradition of the House to give time and attention to vital issues which merit more scrutiny.
	The noble Lord, Lord Carlile, accused the Bill of casuistry, an unwarranted description of both the Bill—which I do not believe is disingenuous—and, by implication, perhaps, even the noble Lord, Lord Joffe. He declared that it would put every doctor at risk and enrich many lawyers. The noble Lord may well have the gift of prescience, but Clause 4 will clearly afford protection if it becomes law. How that law will be interpreted is a matter that no doubt will be decided by learned judges.
	The most reverend Primate the Archbishop of Canterbury—who, unfortunately, is not in his place—said that suffering can be helpful. I would not wish to engage in a dispute with him, but that is a matter for individuals to determine in the course of their life. He then went on to say that we would put everyone at risk and that this would be a substitute for palliative care. Time and again we have heard such allegations made in this debate—but they are assumptions; they are not validated. As has also been said time and again, nothing in the Bill precludes us continuing to be a country which is well respected for its attitude towards palliative care.
	The right reverend Prelate the Bishop of St Albans—who also is not in his place—made an unfortunate analogy, which seems to presume that all those in favour of the Bill are engaging in some kind of wilful misrepresentation by implying that the words that we use do not really have the meaning that they should have. I reject that. I would not impugn his integrity and I do not understand why he should impugn the integrity of those who support the Bill.
	I have a huge respect for the noble Baroness, Lady Chapman—it is unfortunate she is not in her place—but our society has moved a long way from failing to acknowledge the rights of the disabled and children. This Bill is not a prelude to euthanasia in such circumstances.
	The noble Baroness, Lady Emerton, who has just spoken, said that no alternative was offered. It may be that we read Clauses 2 and 3 differently, but they take you through a whole range of alternatives that are put to the individual. She may not agree with my interpretation, but that does not necessarily mean, with due respect, that her interpretation is right.
	At a meeting in this House on 19 April, Professor Raymond Tallis, a geriatrician and former chair of the Royal College of Physicians Ethics Committee, said:
	"I am in support of Lord Joffe's Bill in its present form. There are several reasons for this. Firstly, the current law is a bad law with negative effects. There are a significant number of people who need, and seek assisted dying because of unbearable suffering which cannot be alleviated by even the best palliative care. The result is either botched suicides, currently illegal practices or the need to travel abroad for assistance.
	Secondly, society recognises that the law is unfair and overwhelmingly supports a change in the law. In this, they are supported by many healthcare professionals.
	Thirdly, the proposed Bill has more safeguards than any other legislation of its kind. Lord Joffe's Bill will make the situation safer for both patients and doctors than it is at present where end-of-life decisions are shrouded in medical, legal, and ethical fudge.
	My own change of mind about the Bill is, perhaps, instructive. When the Ethics Committee which I chaired at the Royal College of Physicians first considered this Bill, in 2003, we opposed it and I was in support of that opposition. Unfortunately our decision was based on a series of assumptions: that good palliative care would obviate the need for assisted dying; that assisted dying legislation would stunt the development of our current underdeveloped palliative care services; that there would be a slippery slope in which assisted dying would be extended to people who did not want it or could not give informed consent, particularly those vulnerable people who have been my main professional concern; and that it would break down trust between doctors and patients. Every single one of those assumptions has proved to be false in those countries where assisted dying is available. Indeed, the impact of liberalising legislation has proved to be the reverse of what I had assumed.
	This, then, was why I changed my mind".
	Finally, I agree with the noble Baroness, Lady Williams, that love and respect is what every person deserves. But this can be shown in many ways, and I submit that respecting our loved one's wishes may be difficult but not necessarily wrong. We will all ultimately be faced with the challenge of death and no doubt rage against the dying of the light. This Bill will allow those who so wish to end the struggle, and to do it on their terms. I commend the Bill and I hope that your Lordships will oppose the amendment.

The Earl of Glasgow: My Lords, I agree with what the noble Baroness, Lady Flather, has just said. Seven months ago, when we first debated this Bill, or something very like it, I was taken aback by the number of people who were against it. I was aware, of course, that the Church and people of other faiths were likely to oppose it. If you believe that God, and only God, has the right to decide issues of life and death, it is unlikely that any counterarguments will get you to change your mind. But I could not understand, and maybe this was my own naivety, why so many people were opposing the Bill on very different grounds—in most cases, professional or emotional grounds that had nothing to do with what the Bill was actually saying. We have heard much evidence of that in the debate today so far.
	Supporters of the Bill, such as myself, no longer use such words as "euthanasia" or "assisted suicide" because they trigger subliminal fears and emotions in the hearts of our opponents. We have heard evidence of that today, particularly from the noble Lord, Lord Brennan. They seem to have a vision of a world in which ill people are systematically and quietly put to sleep in nursing homes, where would-be Dr Shipmans have licence to kill, the present trust that now exists between doctor and patient is broken and where the infirm and handicapped will feel constantly under threat. More moderate opponents of the Bill fear that it will encourage doctors to break the Hippocratic oath, that vulnerable old people will be cajoled into wanting to have themselves put down and that the Bill will only confirm them in their belief that they are second-class citizens and that their lives have become useless.
	How do so many people read so much of this into the Bill, when in most cases it seeks to achieve exactly the opposite? Far from encouraging people to end their lives, it proposes that they first consider all other possibilities, especially palliative care, before requesting any form of assisted dying. It is this "slippery slope" argument that opponents have got firmly implanted in their heads which fuels all these irrational fears and distorts the true intentions of this Bill.
	In one sense, the Bill is very straightforward. It has one simple, driving objective: to enable a person who is suffering from a terminal illness to be allowed assistance, at his own request, to end his own life, in his own time and with dignity as he sees it, and to ensure that anyone who helps him in that endeavour—including the doctor who provides the lethal dose—is free from prosecution. We should remember that no one is obliged to help the patient if it goes against his conscience. There is no slippery slope, no secret agenda, no opening of the floodgates to a general legalisation of euthanasia.
	The Bill applies only to people who are in their right mind and who actively, consistently and unambiguously state that they wish to end their own lives. It does not apply to people who might be considering suicide, those suffering from clinical depression or those whose families are persuaded that it might be convenient if they died. It does not apply to vulnerable old ladies who think they have become a nuisance. It does not apply to anyone, however ill or handicapped, who wishes to live their life to the full. The Bill has nothing to do with being second-class citizens, or being regarded as worthless or with one life being of more or less value than another. It applies only to those who crave, who beg or who demand assistance to bring their lives to an end.
	Of course a Bill like this needs safeguards against abuse. I believe such safeguards already exist within the Bill—they have been clearly emphasised by my noble friend Lord Goodhart—but if still greater safeguards are deemed necessary, let them be considered in Committee. To me, the Bill represents a way to end unnecessary suffering. It is a matter of personal choice. It is only you, the patient, who will have the right to decide that your condition has become so unbearable, and your future so bleak, that you wish to end your own life. Not your doctors, not your family, nor—dare I say it?—the Church; only you can make the decision.
	It may well be that the emotional pain will be greater than the physical pain when it comes to making your choice. The onus is no longer on the doctors, and that can surely only help, not damage, the doctor-patient relationship. The sincere and considered desire of a terminally ill patient to be allowed to die should be a human right. Surely, and I address this to the right reverend Prelates in particular, God gave us free will. Why does God deny us that free will when it comes to the approach of death? Why does the Church condone the continuance of unnecessary suffering?
	Few of us know what the cause of our death may be. Surely, however, it must be a comfort to all of us, certainly not a threat, to know that we have some say in the manner of our own dying. It is that human right which I would like to see established in future laws.

Baroness Greengross: My Lords, I add my congratulations to my noble friend Lord Joffe on his courage and persistence in promoting this difficult and sensitive Bill. Having worked almost all of my adult life with older people and on their behalf, I came to the conclusion after many years that most older people I met were not frightened of death or of being dead, but were very worried about the process of dying. I also understand many of the anxieties and concerns felt by disabled people and their organisations. They are worried about this Bill.
	It is an appalling fact that prejudice, even discrimination, against people with disabilities still exists in our in spite of laws to ban their manifestation. I am patron of two disability organisations, and I have to say that the stamina and courage of many people with profound disabilities—and there are wonderful examples of this in your Lordships' House—have inspired me and enriched my life through knowing them. To stamp out negative attitudes and discrimination against disabled people must be a priority for all of us. However, that has nothing to do with this Bill.
	One could say that people with disabilities are discriminated against, as under our law in this country, an able-bodied person can commit suicide, but to need help makes that helper a murderer. I passionately support palliative care and the hospice movement. I was also privileged to meet Dame Cicely Saunders, and I have known many people, including my own father, who died well and peacefully in a hospice with wonderful palliative care. But this is not about a choice between life and death. We are talking about people for whom death is inevitable. It is something that they have almost reached and from which they cannot be rescued. Surely we want to ensure that their dying is peaceful and as pain-free as possible, and that they have time to make their farewells in the way that they wish. It is about the quality of dying.
	Most people do not suffer if they receive good, comprehensive palliative care. That is why I support it so strongly. However, we know that a minority do not. For them, this Bill, were it an Act, would bring a sense of security and the knowledge that, if necessary, they can call on help. For most people, that knowledge is all they need. Experience in Oregon has shown us that the numbers of people asking for help to die is small and declining, because of the availability afforded by this law. It is a form of insurance policy.
	We are talking about adults of sound mind. They deserve the freedom to make decisions about their treatment and care until they are actually dead, not until they are desperate and their wishes and desires can be ignored.

Lord Layard: My Lords, the opponents of the Bill would like us to believe that the present situation is a logical one and that it puts the preservation of life above all else, but, of course, that is not the reality of the situation.
	I would like to give three examples of where people are allowed to die who could have been kept alive. One example is where the doctor himself or herself makes that decision—when a person is deeply incapable and suffering and there is no obvious hope, they decide not to keep the person alive any longer. Secondly, there is the case where the person has made a living will which requires that of the doctor. Thirdly, there is the case where, if you are capable, you can insist that you are not resuscitated if you have a heart attack. All those cases break the principle of the preservation of life.
	The thing which you cannot do, though, if you are capable and in hospital is deliberately to advance your death, either on your own or with assistance, to speak practically. Of course, if you are not so ill and therefore you are at home, you can do it, and if someone assists you, they will not in fact get more than a reprimand. So we have the situation where it is only if you are ill enough to be under 24-hour medical care that you cannot advance your death. I find that extremely illogical. Certainly, it cannot be defended on the ground that we put the preservation of life above everything else in all that we do. You can, in fact, kill yourself unless you are so ill that you need medical help to do it. The majority of people—80 per cent of the electorate—do not agree with that and think that the law should be changed. We should take their opinions very seriously because it is not like an opinion about capital punishment, where you are thinking about what should be done to somebody else; it is an opinion about what you would like to be done to you if you were in a certain situation.
	The problem that we have—it is a very serious feature of the position that we are in as a House—is that the majority of the medical profession are against the Bill. It is extremely easy to understand their feelings because 99.99 per cent of their patients desperately want to go on living, and it is a prime obligation of doctors—it is their prime job—to satisfy the wishes of those people. That leads, of course, to the development of a professional ethic and an instinctive response that that is the overriding drive. But what if a tiny minority want something different—that is the issue—and they are in no position to bring it about on their own? And what if the vast majority of the population think that those people ought to be legally able to have help in bringing about their end? This is a straightforward issue for political philosophy and in my opinion the people have it. I am a passionate supporter of the medical profession and I want it to have more power in the NHS, but this is a matter of people's lives and I think that the views of individuals and of the population ought to be paramount.
	There is the issue of unintended consequences, which my noble friend Lord Turnberg quite rightly raised. For example, would the measure undermine the trust between doctors and patients? I do not see why it should. I note that in Holland that trust is higher than in any other European country, as shown by surveys. Would mistakes be made? Do doctors misdiagnose people as terminally ill? Of course, occasionally, they do. But if the person is in that situation and has no reason to think that they will not have a horrible death, they are in a state of mental distress, and mental distress is at least as important an issue here as physical distress, particularly if the patient says, "I cannot tolerate this situation". That is in the end of the overriding issue—should the choice of the patient be decisive, if the patient is capable? In the NHS that is, of course, always the overriding criterion except in the case that we are discussing. Eighty 80 per cent of the population think that people should have this facility, and so do I.

Lord Kerr of Kinlochard: My Lords, I join those who congratulate the noble Lords, Lord Joffe and Lord Carlile, on the speeches which started the debate. The noble Lord, Lord Carlile, has the advantage of me: it is clear that he finds the issue relatively simple, and the decision that we have to take an easy one. Listening to him I was reminded of the man who said of Lord Macaulay, "I wish I was as sure of anything as Tom Macaulay is of everything".
	I myself find it an extremely difficult decision and one not illuminated by the correspondence we have received. I have read all the letters that I have received, but the correspondence clearly reflects public concerns which do not arise naturally from the substance of the Bill as I read it. First, many people clearly have been led to believe that what is at issue here is euthanasia, and it is not. Secondly, the version of the slippery slope argument which seems most understood by the people who have been following this debate is that somehow in this Bill there exists an infernal machine or a mechanism by which the Bill may expand its scope over time and the safeguards be eliminated or reduced over time. That clearly is and could not be the case.
	Thirdly, many people clearly believe that if the Bill were to become law, the amount of resources available for palliative care, and the attention given to palliative care, would be reduced. That, plainly, is not the case either. I hope that those reporting this debate will take care to address those issues and discuss the scope of the Bill because two-thirds of the concern I detect in the correspondence that I have received is built on these three factors, none of which applies. All of these three concerns are misconceived.
	That said, I do not know whether the noble Lord, Lord Joffe, has his Bill right. What I am pretty sure about is that the existing situation—the law as it stands—cannot be right. It cannot be right that a compassionate act, whatever the circumstances, and in response to repeated requests, must always be a criminal one. We all know—many of us from our own family experiences—that there are many more cases of assisted dying than are prosecuted. We can make an estimate—the noble Lord, Lord Joffe, mentioned 650—of how many cases a year might arise in which people use the procedures set out in his Bill. But we cannot say whether, if the Bill became law, there would be more or less assisted dying than there is today. I suspect that there might be less because the clarification of the law through the specification of the safeguards might actually prove restrictive in its effect, though that is speculation. What seems to me to be not speculation but observable fact is that a rarely enforced law, which leaves a shadow of criminality hanging over those who commit the crime of responding compassionately to a repeated request, must be wrong.
	The present situation is not satisfactory. I do not know whether the Bill of the noble Lord, Lord Joffe, is right, but it seems to me very difficult to accept that the question of whether there should be a permitted procedure, how it should be defined and what safeguards should be built in is not even worth discussing. That is why, having listened to the quality of this debate I hope that the noble Lord, Lord Carlile, will take the same view and will not press his amendment.

Lord Winston: My Lords, I must declare a conflict of interests in speaking in this debate. I am an orthodox Jew and I believe in the basic principle of pikuach nefesh, which is essentially the sanctity of human life. But we live in a pluralistic society and it is very important that when we make legislation and talk about these issues, while our personal background may influence, help and illuminate our opinion, it must be very important and clear to us that we do not expect our opinion necessarily to dominate those of other people. So I will set aside completely my religious views and speak from a purely secular point of view.
	A number of noble Lords have spoken about public opinion; the noble Viscount, Lord Craigavon, the noble Baroness, Lady Thomas, and the noble Lord, Lord Layard. The fact of the matter is that if there is some public opinion, what your Lordships have clearly seen over the past months is an overwhelming response from the public—not from Christian or other religious organisations necessarily—in opposition to this Bill. If we are to test public opinion, we should test it by a different kind of Bill; not by a Private Member's Bill, but by a Bill that is introduced on the basis of some kind of manifesto. I briefly want to argue two points about this Bill.
	Five times in my life I have seen people who are dying who have clearly wanted to die and have expressed that wish repeatedly to me, often over several months. On one occasion, I even filmed that, very controversially, in "The Human Body". A man called Herbie in Ireland, who suffered from mesothelioma, clearly said to the camera, "I want to die; I wish somebody could end my life". Herbie lasted for almost 20 months after that time, and in the last six months of his life he said, "I am so pleased that I was not taken at my word". I have seen that four other times with patients.
	I will tell noble Lords something very personal, which I have not even discussed with my family. My mother is 93; she slips in and out of a pre-dementia situation when she is not entirely with us, and sometimes she is not with us at all. At other times she is quite lucid. Some months ago, she said to me, "I have really reached the end". That was during a lucid period, which is a point to be noted. She then became very confused and aggressive, and she did not know where she was. As recently as last week, suddenly she has found that she is enjoying life again. We cannot predict how people may feel about the future, and to take that view is ultimately the most presumptuous thing that we can do.
	I have one other point. There is the question of old people. I was surprised to hear my friend, the noble Baroness, Lady Greengross, talking about old people in this situation; I must take a different view. The problem is that it is nothing to do with the slippery slope. When old people enter hospital they are often confused, angry and disoriented and they do not know where they are. There are three problems. First, there is the attitude to them. I know that my noble friend the Minister of State is on the Front Bench, and I mean absolutely no disrespect to him or to the Health Service, but he knows as well as I do that geriatric wards and old people's care are constantly under pressure in our very good Health Service. It is inevitable that it will be so. You see it in many wards, and I have seen it myself with my mother's care. People are left soiled, they are called by their first name, and they are not treated with dignity. They lose themselves, and as they become angry and disoriented they cease to be people. First, they have the attitude of devaluing themselves; secondly, they may be devalued by other people, and we ourselves may devalue them. Recently with my mother, I have sometimes wondered privately if it would not be better to end it. That is the problem, because this week she is sapient, conscious and able to hold an intelligent discussion. We need to respect the hoary head, in this House above all. I urge noble Lords to reject the Bill.

Baroness Howe of Idlicote: My Lords, we are about half-way through a debate that has been immensely impressive and informative on both sides of the argument. I particularly empathised with the comments of the noble Lord, Lord Winston.
	A week ago, I was with a friend who has suffered greatly in recent years. He has suffered enough to induce him to make more than one attempt to end his own life. He said to me, "I'd never heard the phrase 'palliative care' until very recently. And it has made all the difference"; and so it has—to the whole argument.
	If we were still talking about dying in pain, I might have been much more inclined to accept the case for a change in the law. But I cannot in all conscience do it for what seems to be a quite different concept—for what the Select Committee called "existential suffering". Assisted dying in that context can all too easily come to mean accelerated dying, instead of what surely must be much more acceptable for family and for patient: tolerable dying; bearable, dignified dying.
	Just what that means was made clear to me by journalist and broadcaster Daisy McAndrew's account of the recent death of her father, Alistair Sampson—a lifelong friend—in St John's Hospice, the only independent hospice in central London. This extract gives a flavour of the article:
	"The hospice staff never patronised my father or anyone else in the family and managed to make the process dignified and special. We never doubted how much they cared for him and for the rest of us. My dad was delighted and comforted by them. Their honesty and intelligence in the way they cared for him enabled him to be on the very best form he could be".
	Contrast that with the Select Committee's deeply depressing description of the typical Oregon applicant for medical assistance with suicide. It states that,
	"they want control of the dying process and wants to avert having to be cared for in a way that is offensive to them",
	and that,
	"they find being cared for to be intolerable".
	For me, those quotations, far from making the case for accelerated death, make exactly the opposite case for continued enhancement and increased availability of palliative care.
	It is that which needs to be achieved nationwide, and certainly there should be an end to the current postcode lottery. There should be more hospice and community care, and more state resources for that, not more suicide. For me, St John's Hospice makes a much stronger case than the state of Oregon. I cannot support the Bill.

Lord Griffiths of Burry Port: My Lords, I am the third Methodist minister to speak in a short period, and the one who has chosen to stand a little above the Bishops. I will limit myself to one or two more forensic, rather than ideological or theological, points.
	I was impressed among the welter of material that came my way to read a submission from the Motor Neurone Disease Association, which declares that it is neutral on this question, but argues that if autonomy and freedom to choose are really what we seek, there would be no genuine choice for those in its client group until the very best palliative care was available to all who needed it. In other words, it is not available now; the question of choice is, therefore, inappropriate and perhaps the timing of this initiative is wrong.
	I was educated by the last debate, which encouraged me to read—as a new boy in the House and I had not at that stage been part of the whole process—the Select Committee's report and the evidence that supported it. The All-Party Group on Dying Well makes the point that the Bill takes little or no account of the safeguards that were asked for in the Select Committee report, and it instances in detail the ways in which the Bill falls short of what of what was recommended in that report.
	In a process that has clearly taken a number of years and has had several set-piece debates, with lengthy consideration from a large number of sources, how can the all-party parliamentary group conclude does it come about that, with the safeguards asked for not met, the all-party parliamentary group can conclude that the plain fact is that the Bill is not safe to be passed into law? If there is any truth in that conclusion, how can we assume that moving into Committee will give us greater guarantees that, by amendment, we will achieve those objectives? I find that very difficult.
	Finally, the report states that,
	"the number of people who might be regarded as serious about ending their lives, who are not psychiatrically ill and who are unlikely to be deflected from their purpose is very small indeed and comprises to a large extent terminally ill people who have strong personalities and a history of being in control of their lives and whose suffering derives more from the fact of their terminal illness and from the loss of control which this involves than from the symptoms of their disease".
	I find that very compelling. Incidentally, in his opening remarks the noble Lord, Lord Joffe, quoted from that section without going quite as far as I did. To legislate for such a small number of people seems to me to do more than cross a Rubicon; it imposes the views of a tiny minority on the population at large when we have been arguing constantly throughout this debate that theologically motivated people have no right to impose their views on anyone else. For those reasons—although I would love to have a jousting match with the noble Lord, Lord Pearson, on the theological points that he introduced—I find myself not only against the Bill but against taking it any further at this stage.

Lord Ahmed: My Lords, I, too, thank the noble Lord, Lord Joffe, for introducing the Bill and giving us the opportunity to discuss this highly sensitive and controversial subject. It is impossible for me to respond to all the e-mails, letters and communications that I have received from hundreds, and possibly thousands, of people wishing to share their opposing views on the Bill, so, through this debate, perhaps I may thank them for their concerns.
	References were made earlier to the right reverend Prelates and the Christian communities. I stand before your Lordships as a Muslim supporting faith communities and others who believe that life is sacred and that only Almighty God, the creator of all, has the right and the power to end anyone's life, even if the patient is old, disabled and "terminally ill". Chapter 4, verse nine of the Koran says:
	"Do not kill yourselves for verily God Almighty has been most merciful to you".
	I am also seriously concerned that the rights of ethnic minorities, who are often more vulnerable as a result of language barriers and cultural differences, would be eroded. Large numbers of the Muslim population here work in, or are patients of, the National Health Service and they have the right not to be exposed to what is proposed in the Bill. We also have a responsibility to the rest of the world. We are on the international stage on so many issues. We cannot willingly allow the collateral consequences of our actions to kill off the humane development of palliative care services around the Muslim and Arab world.
	We have a duty to alleviate suffering, as has been said by many speakers, but by killing the pain and not the patient. The hospice movement set up in the UK is a beacon of excellence worldwide, showing that suffering can be relieved. Doctors have for 2,000 years regarded helping patients to kill themselves as inconsistent with their role as healers. True dignity is not premature death made possible by a doctor but is, instead, dying naturally with one's physical, social and spiritual needs properly met. The Bill would contradict both the Hippocratic Oath and British legal tradition. The advances made in research and development in the fields of analgesia and palliative care would be halted.
	In today's medical world we have the technology, medication and skills to treat patients' symptoms in their early stages of life. I urge your Lordships to vote against the Bill. However well intentioned it is, it would have serious consequences for terminally ill people if it became law.

The Earl of Onslow: My Lords, my father, who died aged 57, said to me in the mid-1950s, "I used to be in favour of euthanasia until I listened to a debate in their Lordships' House". I looked up that debate from 1950 and I saw why he had had his mind changed. There was also a reference in that debate to a 1936 Bill for euthanasia, against which, I am proud to say, my grandfather voted—I see no reason why his grandson should not vote against this Bill today, despite the colour of his socks.
	When my father was dying, I was absolutely longing for him to die, because he was in such great pain. I almost said—in fact, I probably did say—to the doctor, "Please can't you give him something?" The doctor was Irish and had been trained at Trinity College Dublin in 1923. He obviously did not do so deliberately, but he made absolutely sure that my father suffered no pain. That seems to me the way it should happen. Incidentally, he said in front of my stepmother after my father died, "Michael, you have three Lady Onslows to look after, and a very wary path you will have to tread between them". He was the best of old-fashioned doctors who instinctively understood palliative care.
	The Bill will not only permit assisted suicide, but by implication encourage it. That is why it is wrong. As the noble Lord, Lord Phillips, said, this matter is so complicated that it is too complicated for legal definition. In my view, it is somewhere where you need an element of hypocrisy, which allows you to pretend one thing and possibly do another, but you know that you have got to deal with the integrity of the doctor and of the medical profession.
	The main reason my father's mind was changed was the point made by several noble Lords. The noble Lord, Lord Tombs, made it so accurately when he said that the Bill will encourage those of a mean-minded disposition who possibly have hopes of an inheritance to get their hands on that inheritance earlier. The Bill will encourage, not just permit, assisted suicide and, above all, it will make the noble Baroness, Lady Symons, subject to greater pressure. After we heard the noble Baroness's speech, which was totally gut-wrenching, we probably should have stopped the debate, voted and slung out the Bill on the basis of her speech alone. I will, with pleasure, in memory of my father and in honour of the noble Baroness, Lady Symons, vote against the Bill.

Lord Desai: My Lords, we have not seen so many Bishops here since the debate on Sunday trading. Obviously, death is the business of the Church and it does not want it to be hastened. Religion relies on fear and the religious love suffering. I am an atheist and I have no fear, certainly no fear of God or the afterlife. I value my life, but I value it for the pleasure it gives me, and as soon as I cannot derive any pleasure, I want to be rid of it. I have always liked the Bill because it gives me autonomy. The right reverend Prelate the Bishop of St Albans said that autonomy is one of the dangerous diseases that are completely contrary to human nature. Well, that may be in the Church of England, but the rest of us who are not Christians, Muslims or Jews have a mind of our own and therefore we like personal autonomy. I cherish my personal autonomy, and if I were to lose it to some religious dogma, I would be very sorry indeed.
	The conservative argument has a constant structure whether applied to House of Lords reform, the Speakership of your Lordships' House or assisted dying. The first element is the slippery slope: "You do this, and the next thing you know, you will all be killed whether you like it or not". The second element is adverse consequences, to which the noble Viscount, Lord Tenby, has just referred: "Whatever we do, what happens will be contrary to what we intend or an exaggerated version of it. Those who do not like change always say it, regardless. I should not say "Thank God" but thank somebody or other, thank the random numbers, change happens. As the noble Earl, Lord Arran, said, his father had to introduce a Bill on homosexuality reform four times. Eventually, it happened.
	This happens to be the birthday of the noble Lord, Lord Joffe. Normally I would congratulate him, but I hope he lives long enough to introduce this Bill again and again, until we get what we want. We shall fight and we shall fight on.

Lord Swinfen: My Lords, when a healthy adult commits suicide, they are normally found to have done so when the balance of their mind was disturbed. That means that we as a society have let them down. We have not given them the support they needed, spiritually, psychologically or with friendship. The same applies to those with terminal illnesses who request assisted suicide. We would not dream of giving a healthy adult the means to commit suicide. Why, therefore, should be we ask doctors whose task it is to secure and support life to give terminally ill patients something with which they can commit suicide? So far as I am concerned, that goes right against the ethos of the medical profession.
	It used to be said that hospitals were places where you went to die. That is not so today and I do not want it to become so again. This Bill could lead very easily to a slippery slope and things could get a lot worse. Rather than just the terminally ill, those with severe disabilities and those whom their family think are a burden will also consider this option. And let us not forget that in Select Committee on 16 December 2004 the noble Lord, Lord Joffe, who has introduced this Bill, said:
	"We are starting off. This is the first stage".

Lord Hylton: My Lords, I wonder whether my noble friend Lord Joffe really understands the strength of the opposition he has aroused. The great faiths are united against the Bill, more so even than was shown by the letter to The Times today. The new organisation, Care NOT Killing, received 10,000 signatures petitioning against the Bill. Surely this is a record for a Private Member's Bill.
	The medical professions are fairly solidly against the proposals. The Royal College of Physicians, with 23,000 members, states:
	"Good clinical care can be provided within existing law, so that patients can die with dignity".
	I hope that that will satisfy the many agnostics. In fact, no royal college favours changing the law.
	My noble friend Lord Joffe said that more than 70 per cent of public opinion, as measured by polls, supports a change. I suggest that that turns very much on how the questions are put. CommunicateResearch, in a recent poll, found that 65 per cent agreed that the Bill would put pressure on vulnerable people to opt for suicide; 73 per cent thought it would become harder to detect rogue doctors, as in the case of the late Dr Shipman; 75 per cent thought that people with treatable illnesses, such as severe depression, would prematurely wish to end their lives. These are very serious matters.
	The Bill risks destroying the remaining trust between old and sick patients and their doctors and carers. Here I agree with the noble Lord, Lord Turnberg, about the practical and unintended consequences, such as improper pressures.
	I urge my noble friend to withdraw this divisive Bill, though he has moved it from the highest motives. Otherwise, I must vote against it.

Lord MacKenzie of Culkein: My Lords, I declare an interest: I am a nurse. I know that some nurses, whose opinions I very much respect, support the Bill and even seek to do so from an ethical standpoint, but I cannot agree with them. I cannot support any legislation which will, in my opinion at least, jeopardise the future of the nurse/patient relationship. I am therefore pleased to note that the collective voice of nursing is very much opposed to the Bill.
	The Bill clearly sees the involvement of nurses in the process of assisting death. We have heard much today about choice and autonomy, but you cannot exercise choice and autonomy without involving doctors and nurses. It is not something you can do on your own. Although there is a clause dealing with conscientious objection, I am of the view that it cannot really work in all the care settings where end-of-life care is delivered. The prospect of encountering a patient wishing to take advantage of physician-assisted suicide will not be restricted to those working in palliative care. I feel very strongly that it is not part of their practice for any palliative care nurse to be involved in any process whatever of obtaining assisted dying.
	We have already heard about the slippery slope, not least about the cultural shift in the UK since the introduction of the Abortion Act 1967. The situation is self-evidently very different today from that envisaged by the noble Lord, Lord Steel of Aikwood. I make no complaint about that because I firmly believe that women have a right to control their own fertility. Some noble Lords have said that there will not be a slippery slope yet, but I am not so confident. I think that there is bound to be a demand for further legislation to legalise euthanasia. The noble Lord, Lord Joffe, said today that he has changed his mind about the legislation going forward in incremental stages. I greatly respect and welcome his revised position. But others will surely not be so content if the Bill is enacted—they will want to take the matter further.
	I do not believe that this is what the values of the nursing profession are about. I also believe that if the Bill ever becomes an Act, it will severely damage the development and continuation of palliative care, not least if that inevitable cultural shift takes place and the population becomes conditioned to a cheaper option of physician-assisted dying or euthanasia. The noble Lord, Lord Elton, said that money drives policy. That is fairly hard-nosed, but he is right. We know that that is what happens in the real world.
	It goes without saying that, wherever possible, death should be pain-free and dignified. If there was universal—I emphasise that word—availability of hospice care, not just for malignancies but for diseases such as motor neurone disease, if there was hospice care at home and good symptom and pain control, a lot of the fear that engenders the demand to be allowed to choose assisted dying might be removed. The lessening of that fear would be materially assisted if there were less media hysteria and misinformation—for example, that people living with motor neurone disease choke to death. That simply is not true.
	I do not want to damaged in any way the trust of patients in nurses and physicians or the terminally ill in their relatives and carers. I do not believe that the Bill provides sufficient safeguard where someone who appears to be terminally ill feels that they are a burden on their family and carers and where—this is the real world, after all—there might be greed and malice aforethought.
	The prescribing doctor will not be present when the lethal cocktail is taken. Who is to know who administers the drugs? For me, any doctor or nurse who sets up an intravenous line or nasogastric tube where there is an inability to swallow must come very close indeed to practising euthanasia. For all these reasons, and many others which time does not permit me to give, I will support the amendment in the name of the noble Lord, Lord Carlile of Berriew.

Lord Maginnis of Drumglass: My Lords, the noble Lord, Lord Joffe, said that his last Bill was,
	"based on the principle of personal autonomy and patient choice, the right of each individual to decide for themselves how best he or she should lead their lives".
	I assume that the same principle of personal autonomy underlines this Bill. Yet surely he agrees that society must have laws restraining us from doing those things that may harm others. On that basis alone, his "personal autonomy" justification fails.
	Unhappily people do attempt to commit suicide, and one does everything possible to prevent them succeeding, including trying to resuscitate them. Society views that as its duty. Although the individual is probably, in the words of the Bill, "suffering unbearably", society makes clear, in the time-worn words of successive coroners, that suicide indicates that the balance of the mind is disturbed, so society promptly suspends the suicidal individual's personal autonomy. Yet this Bill, which would make it lawful to assist suicide for the terminally ill seemingly because, the moment one is told one is going to die shortly of natural causes, it is no longer to be considered a sign of mental imbalance that one should want to accelerate one's death. In the case of the terminally ill, the Bill presumes mental capacity where, if the motivating trauma was different, that presumption would be the exact opposite. That just does not make sense.
	There, due to time constraints, I rest my case. I have received hundreds of letters, many of them laboriously hand-written, and hundreds of personal e-mails. None was abusive. Only one that was written to me was in support of this Bill, and I believe that reflects the will of the vast majority. I urge your Lordships to reject the Bill.

Baroness Wilkins: My Lords, I am totally opposed to this Bill. It is a dangerous Bill. Contrary to the views of my noble friend Lord Hughes of Woodside, it only masquerades as a modest Bill. If it were to succeed, it would remove the cornerstone of our law that protects us when we are at our most vulnerable. If we cross that threshold, society's attitude will inevitably change. It is for that reason that we have all been inundated with pleas from disabled people to reject the Bill. Severely disabled people know vulnerability only too well, subject as we are to the widespread prejudice that the quality and therefore the value of our lives is less than that of non-disabled people. Regardless of the high-profile individual cases such as Dianne Pretty, no disabled people's organisation, national or local, has supported the Bill.
	In Committee Room 4 today, a new organisation was launched called Not Dead Yet UK. It comprises a group of influential disabled people who have helped ensure that disabled peoples' fears have been properly heard for the first time in relation to the campaign of the noble Lord, Lord Joffe. This was no tactic. They fear the Bill not because they have been told to, as my noble friend Lord Hughes suggested, but because their life experiences have taught them to be afraid. They and I believe that legalising assisted dying will inevitably lead to increasingly adverse judgments about the quality of our lives. I say to noble Lords, please do not let that happen; vote against the Bill.

Lord Mackay of Clashfern: My Lords, I begin by declaring my interests as the president of the Scottish Bible Society, a patron of the Lawyers' Christian Fellowship and a supporter of a number of Christian and welfare groups.
	As your Lordships will know, I was the chairman of the Select Committee set up to examine a previous Bill in this field, brought forward by the noble Lord, Lord Joffe. At the committee's first meeting, it was apparent to me that its Members held strong views for and against the Bill. I felt that a report stating that so many were for and so many were against that Bill was not likely to be of use to your Lordships in further consideration of such matters. Therefore, I felt that, if we could, we should try to assemble a factual report on the matters relating to the Bill and that we should engage together in a thorough examination of those factual and weighty issues that might assist your Lordships to reach mature judgments on them—issues of life and death.
	In order to do that, I determined to embrace a strictly neutral stance at all stages of the committee's work and I have tried to follow that decision until now. The work of the committee has now concluded with publication of its report and a Take Note debate on it in your Lordships' House. I hope that noble Lords will agree that it is appropriate for me now to express my own point of view.
	Before doing so, I wish to mention a recommendation of the committee, to which the noble Lord, Lord Joffe, referred: that there had already been a Second Reading on a very similar Bill, followed by a Second Reading while the Select Committee was still engaged on its remit, in order for a renewal of its mandate. With a full report with the evidence that we had taken and a Take Note debate, it seemed appropriate that after a further formal Second Reading, a further Bill on the same basis should be remitted to a Committee of the Whole House. Of course, we appreciated that if the House wished to have a Second Reading debate, that would happen and our recommendation could be rejected.
	A strong factor in that recommendation—at least so far as I was concerned, and I think my view may have been shared—was that the previous Bill had included provisions whereby a patient could be given a substance which he or she could take and, if the patient was incapable of doing so, the doctor could take action to bring the patient's life to an end. So there were two distinct sets of provisions in that Bill, and the noble Baroness, Lady Hayman, had different views about their validity.
	Obviously, when there are two such distinct provisions in principle, a Second Reading debate would not be able to resolve the issues. A Second Reading debate can deal only with a Bill as a whole and therefore two distinct provisions cannot be dealt with separately. On the other hand, in formulating this Bill and having no doubt considered the views of members of the committee that were known to him, as well as the evidence relating to the Netherlands, as he mentioned this morning, the noble Lord, Lord Joffe, decided to produce a Bill containing only the main provision: that of the doctor assisting by providing the necessary prescription. The precise basis for that recommendation from the committee has been somewhat altered by the provisions that the noble Lord, Lord Joffe, has adopted in this Bill.
	It is clear from the evidence that we took in Oregon that only a small number of prescriptions had been issued over the years since the legislation there came into effect and that a high proportion—perhaps something of the order of 50 per cent or even more—had not been used. Prescriptions were issued by doctors after patients had determined that they wished to die but then quite a high proportion of those patients did not take up the prescription. That is an indication that, even if it appears definitive, a decision to embrace assisted suicide may be provisional.
	As my noble friend Lord Arran has already said, the evidence indicated that people who used the prescriptions were those who had been in the habit of exercising very strong control in their own lives and who found it impossible to accept the prospect of losing that control as a result of a terminal illness. They were not necessarily in severe physical pain in the sense that I understand it but in what has been called "existential" pain or mental anguish. The evidence showed that the number of such people was relatively small. That fact has been emphasised by the noble Lord, Lord Joffe, today and it is supported, for example, by my noble friend Lord Arran.
	We took evidence from a great number of people. Among the witnesses were severely disabled people who expressed anxiety about the Bill. However, I felt that they may have misunderstood it and I said to one particular person, whom I remember very well, that this Bill—of course, when I spoke of "this Bill", I was talking about the previous Bill introduced by the noble Lord, Lord Joffe—did not contain any threat to her or her colleagues because it dealt only with terminal illness. Terminal illness was defined in that Bill as being of a limited time but it was expressed a little more ambiguously than in the present Bill, where the time limit is defined as six months.
	I tried to understand why the lady felt that the Bill was a threat. I hope that I summarise fairly when I say that she took the view that, if doctors could properly help to end a heavily burdened life in the circumstances described in the Bill, that involved a judgment on the value of a heavily burdened life. She felt that she was in the category of having a heavily burdened life, which accentuated the burden.
	There are many more disabled people—some of them heavily disabled—in this country than there are likely to be beneficiaries of this Bill, if the evidence from Oregon on which it is founded is to be relied on. I feel strongly that I do not wish to add to the burden of heavily burdened lives lived by those who may be disabled. I do not wish to add to their burdens while they live a heavily burdened but successful and challenging life, which challenges all of us in what they can achieve in the face of their disabilities. We have had the privilege in this debate of hearing from people who are disabled. The message from them seems to be rather the same as that which I took from the evidence of the disabled lady.
	The question is whether the Bill should be allowed to proceed or whether it should be postponed, as proposed by the amendment of the noble Lord, Lord Carlile. If the Bill in principle were acceptable or were capable of being put into an acceptable form by amendments in Committee, it would be right that it should proceed. For my part, in the light of my conclusion to which I have just referred, I do not think that that is so. I will support the amendment tabled by the noble Lord, Lord Carlile, if it is moved.

Lord Joffe: My Lords, I can explain the delay in asking for a Second Reading. I was given very few Fridays. My problem was that the noble and learned Lord, Lord Mackay, was not available on the days that I wished in March and earlier. In the end we chose 12 May—which, being my birthday, was hardly the date I would have wished to select—in order to the meet the needs of the noble and learned Lord, Lord Mackay. In fairness, he told me initially—and there was correspondence between us—that, in his view, it was not essential that he should be at the Second Reading. However, it seemed to me that the chairman of our Select Committee should be given the courtesy of the opportunity to be present at the hearing on this Bill.

Lord Carter: My Lords, that does not answer my question. If the noble Lord had really wanted a Committee stage, why did he wait six months?
	It has also been said that the Bill can be killed at Third Reading. It cannot. It can be killed only on a Motion that "This Bill do now pass", after all the amendments are considered on Third Reading. The House authorities have made absolutely clear that it is perfectly proper, and indeed principled, to oppose a Bill of this nature at Second Reading. Their advice is unequivocal. The Companion to Standing Orders sets out very clearly the proper procedure for opposing a Bill at Second Reading, and that is being followed. The Companion also states:
	"There is no procedural distinction between bills sponsored by a minister and those introduced by other Members of the House".
	This Bill is a public Bill and the argument for different treatment because it was introduced by a private Member is just plain wrong. The Motion tabled by the noble Lord, Lord Carlile, is unusual but it is not unprecedented. It is fully within the conventions and precedents of the House to oppose a Bill at Second Reading.
	For all the reasons that I have given, the perception outside the House is that the Bill might become law if it remains on the parliamentary agenda and the timetable chosen by the noble Lord, Lord Joffe. I shall have no hesitation in voting "Content" if the noble Lord, Lord Carlile, divides the House. But the final decision is really for the noble Lord, Lord Joffe. He has certainly obtained the publicity he was seeking and was entitled to seek. He has done a signal service in bringing the question of palliative care right up the health agenda. Even at this late stage, I would urge him to recognise parliamentary reality and the fears of those outside this House by not moving the Motion to commit the Bill, and effectively to withdraw the Bill for this Session.

Baroness Barker: My Lords, we all come to this debate with a predisposition to support or oppose the proposals before us. That predisposition is derived from our knowledge, belief, culture and experience. There is a spectrum of opinion, from one end which holds euthanasia to be an acceptable part of caring treatment, through to that for which any intervention is unacceptable. We have heard the shades of that today.
	For myself, the critical point is the involvement of doctors. Doctors should never be the means by which political, social or economic ends are pursued. The flaw in the proposals of the noble Lord, Lord Joffe, is one to which he drew attention himself—that it is deficient in its strictures about what doctors and other medical practitioners such as nurses can do.
	On vigilance, which has been mentioned, Clause 12, establishing the monitoring commission, must be extensively examined, not least because of the experience in the Netherlands. Furthermore, the appointment, composition, powers and resources of those monitoring commissions needs to be explicitly on the face of the Bill and not left to regulation.
	Many noble Lords have talked today about the slippery slope, and others have countered with evidence form other jurisdictions. The problem is that the systems about which we have heard today operate in a context where the healthcare system is different, where the culture is different, and where there is no national health service. I suggest that we need evidence from this country of how the Bill, if implemented, would work in our society. Therefore, I believe that one of the omissions in the Bill is provision for a statutory review of the legislation. I want to see in this country a system where people with conditions such as motor neurone disease can make individual decisions about their treatment and do not have to go abroad in order to exercise that choice.
	I want to challenge my noble friend Lord Carlile—a perhaps difficult task. I do not believe that his proposal is improper, but I do believe that it is inappropriate. My noble friend has been quite clear. He told the House on 10 November that there is no condition that palliative care cannot address in order to help the individual. Some of us do not have that certainty. Therefore, while he believes that the Bill cannot be made acceptable by amendment, some of us remain unsure.
	Furthermore, this is exactly the kind of issue that should be subject to the detailed and expert scrutiny that it would undoubtedly receive in your Lordships' House—a scrutiny which it would be unlikely to receive anywhere else other than in a court. Your Lordships, unelected as we are, can listen, evaluate, and concur with or reject lobby campaigns. We alone are able to act as we see fit. I share the desire of my noble friend to limit the income that lawyers may derive from this legislation and to see that whatever emerges is as clear as possible.
	At the end of this debate—the fourth debate since the Select Committee chaired by the noble Lord, Lord Walton, and informed by the report of the Select Committee chaired by the noble and learned Lord, Lord Mackay of Clashfern—it is still possible to change one's mind. Perhaps the most important statement today was that made by the noble Lord, Lord Joffe, when he opened the debate and told the House how he had come to change his mind. Further debate should not necessarily follow public opinion, but it would have a distinct role in informing public opinion. That would be of value.
	The aim of all of us who have taken part in this Bill in any way is to secure for ourselves, for those whom we love and for those whom we do not know humane treatment and a dignified end to life. I am not sure whether the noble Lord's Bill as it stands would be able to achieve that. But I do not believe that at this stage we should give up trying to see whether it is possible to produce legislation that continues to safeguard individuals and enables them to make the most difficult decision they will ever have to make.

Lord McColl of Dulwich: My Lords, I want to give a message to the House from my noble friend Lady Park of Monmouth, who is in hospital. We have great respect for her all around the House. The message she wanted me to give was that she is very much opposed to the Bill.
	I have another message—from the leader of our party, David Cameron, who says:
	"We should not allow doctors or others positively to accelerate death because I think the long-term consequences of permitting such action are too likely to be dangerous for society. But there will be a free vote".
	As noble Lords know, at 5.20 am on 11 December last year, there was a massive explosion at the Bunsfield oil depot in Hertfordshire. Three days later, we received the explanation of what went wrong. My noble friend Lord Newton of Braintree chaired the committee, which found that two safety devices failed, the tank overflowed and so the disaster happened. That disaster illustrates what happens when safeguards do not "fail to safety". Failing to safety would have meant that a malfunction of the safety devices would have stopped the tanks filling up and the disaster would not have occurred.
	Noble Lords may be wondering why I refer to those matters and think that I have come to the wrong debate, but I want to illustrate that the law, as it now stands, fails to safety. It errs on the side of life and protecting the vulnerable. For all its intended safeguards, the Bill will not fail to safety. The present law errs on the side of life; the Bill will err on the side of death. That is all the more worrying because when the safeguards in the Bill fail, there will be no explosion. There will not even be a whimper. The failure may never be discovered, because the patient will be dead. It will then be too late to find out whether the request for assistance in dying was truly voluntary. It will be too late to discover whether the patient's decision to seek assistance in dying was truly an informed decision. It will be impossible to discover whether the patient, had he lived, would have looked back and been grateful for the fact that he had not been assisted to die.
	I, too, was very moved by the speech of the noble Baroness, Lady Symons of Vernham Dean. It reminded me of Alison Davies, who wrote to me recently and gave evidence to the committee. Several years ago, she was diagnosed with a terminal illness. She was also quite severely disabled. She wanted euthanasia. Of course, that was refused. Difficult although it was, she tried to commit suicide on several occasions, but was always rescued by her friends, who persuaded her that life was worth living.
	Then she took on a new lease of life and started looking to help other people. She says:
	"If Lord Joffe's Bill had been law, I would have taken advantage of it and been killed and I would have been deprived of the best ten years of my life and the thousands of orphans in India that I have been helping would have been deprived of my services".
	How do supporters of the Bill answer Alison Davies?
	If anyone is totally confident that the safeguards in the Bill are foolproof and impregnable to error, exactly what is the basis of that confidence? Does it rest on the solicitor who will sign a declaration to say that the patient appears to be of sound mind and that the declaration appears to be made voluntarily? If so, that confidence is misplaced—not because the solicitor will not do his honest best but because the solicitor has no special skill or training that enables him to discern the mental capacity of the patient. Furthermore, he has no way of knowing whether the declaration is truly involuntary. We all know that appearances can be deceptive. A solicitor serves to give the declaration a spurious gravitas, but that is not a true safeguard. Judged objectively, no one can be satisfied that the safeguards in the Bill will always be sufficient and effective. Patients know this, of course. To pass the Bill would therefore not only disadvantage patients but would also risk undermining the trust between doctors and patients, as the noble Lord, Lord Nickson, has said so eloquently.
	If the Bill becomes law, I could put a lethal tablet in the hand of patient who had made the declaration, and if he swallowed it and died, that would be lawful. If, on the other hand, I took the pill and put it on his tongue and he died, that would be illegal. If he is incapable of moving his hand at all, and I put the tablet on my hand, put it within a few centimetres of his mouth, and his tongue whipped out and took it, would that be lawful? As he is the one taking the medication, I am simply acting as a sort of platform. This is far too fine a distinction for law. Considered from the point of view of the patient, it is also an unprincipled distinction, and one that would not be sustainable in the long term. Proposers of the Bill should know this. They probably hope that the Bill will prove to be a significant and first step on the road to lawful euthanasia, but sometimes first steps are best not taken. This is one such step.
	A few years ago, supporters of the Bill were very much in support of euthanasia as practised in Holland. But they now seem to be moving away from that position. The present Bill now involves only assisted suicide, but that is where it all began in Holland. Within a few years, they moved to euthanasia for depressed patients, for disabled patients, and then for newborn babies. There is now a proposal that people over the age of 75 should be considering this. When I look around the Chamber, I see that that might involve quite a few people here. Once the law permits for the first time a particular action such as euthanasia, even though it is only for a few people, the law cannot prevent the boundaries being extended. That is the problem. Some Dutch doctors have actually been disciplined for not agreeing with the principle of euthanasia. One Dutch doctor was no longer allowed to teach medical students because of that.
	It is worth mentioning again that when a Dutch doctor was asked what his first case of euthanasia was like, he said, "It was dreadful. We agonised all day. But the second case was much easier, and the third case was a piece of cake". Many elderly people in Holland are so fearful of euthanasia that they carry cards around with them saying that they do not want it. I was so glad that the noble Lord, Lord Stoddart, mentioned the death penalty. Other noble Lords mentioned polling. It is true that many polls show that British people want the restoration of the death penalty, but presumably we would not countenance that. Why? Because misinformation leads to wrongful conviction. Misinformation to patients leads to wrong decisions, too. Forecasting the outcome of disease is also notoriously difficult. I very much agree with the noble Lord, Lord Turnberg, that the risks of the Bill are too great, and with the noble Lord, Lord Carlile, who described the Bill as a legal minefield and an ethical nightmare, morally indefensible and completely unnecessary.

Lord Warner: My Lords, as speaker No. 90, I should like to follow the noble Lord, Lord McColl, with a few messages from the Government, which may be a little more complex than his messages. I am grateful to the noble Lord, Lord Joffe, for devoting his birthday to introducing this revised Bill and for setting out the intentions of the Bill so clearly. It provides us with a further opportunity to consider this important and sensitive subject. There is no doubting the commitment of the noble Lord, Lord Joffe, to this issue, nor the compassion that drives him. Nor is there any doubt that others are equally committed to opposing this legislation. I should like to pay tribute to the moving personal experiences of several noble Lords and their willingness to share those experiences with us. I am particularly indebted to my noble friend Lady Symons for her moving speech.
	This remains an emotive and profound subject, which continues to elicit strong and often opposing views. Sadly, as I know from my own postbag, it can produce intemperate and offensive expressions of those views, which, I have to say, were greatest from those who were opposed to the Bill. As noble Lords have mentioned, your Lordships debated this matter in detail last October when there was considerable balance in the number of Peers who would and would not oppose the Bill. The noble Lord, Lord Joffe, told us that he would revise the Bill's provisions in the light of the points raised. On behalf of the Government, I want to make it clear that, as in October, they are listening carefully to the debate on this complex ethical issue. We consider that it is right that Parliament should lead on this debate and should provide the forum where all shades of opinion can be heard. Therefore, in accordance with the conventions of this House, the Government will not seek to block this Bill being given a Second Reading.
	There has been much discussion of what would and would not be allowed under this Bill were it to become law. I want to take a moment to remind us of the situation today. It is important that the legal position is clearly understood. Let us be absolutely clear: euthanasia—which is commonly understood to be the intentional taking of life, albeit at the patient's request or for a merciful motive—and assisted suicide are unlawful. Anyone alleged to have taken active steps to end another's life would be open to a charge of murder or manslaughter. Anyone alleged to have assisted a person's suicide would be open to penalties of up to 14 years' imprisonment under the Suicide Act 1961.
	This Bill introduced by the noble Lord, Lord Joffe, proposes that in certain restricted circumstances doctors should be able to assist a competent patient to end his or her own life. This is the issue that your Lordships are being asked to consider and that I am reflecting on today as a Government Minister. I remind your Lordships that we are not dealing with matters around withholding or withdrawing treatment or a person's right to refuse treatment, even if that refusal may result in his or her death. These are also important issues but they have nothing to do with the assistance to die that the Bill seeks to introduce. These issues should not be confused.
	I also want to make it clear that there is no connection with the Mental Capacity Act. The Assisted Dying for the Terminally Ill Bill specifically relates only to competent adults. The Mental Capacity Act, on the other hand, deals with people who lack capacity to make decisions. There is no connection at all between the two. The Mental Capacity Act also has nothing to do with euthanasia or assisted suicide. Section 62 of that Act makes it quite clear that it does not change the law on murder, manslaughter and assisted suicide.
	I am also aware of the increase in public debate on this issue. Noble Lords have mentioned the work of particular groups: for example, the setting up of the umbrella organisation Care NOT Killing to campaign against the Bill and the work of the renamed Dignity in Dying, which supports the Bill. We have all observed that there has also been a notable increase in correspondence. And we have heard about the recent changes in the stance taken by a number of professional bodies, and how those have been arrived at.
	The noble Lord, Lord Carlile, and others mentioned the recent statement from the Royal College of Physicians on its members' views. As I understand it, the college sought the views of 16,400 plus fellows and members. It had a response of 5,111, which I calculate is a response rate of around 30 per cent Seventy-three per cent of this group felt that a change in the law is not needed. Does that mean that this or any poll carried out in the same way speaks for all doctors or just for those with strong views on the issue one way or the other? It certainly does not seem to me to support the conclusion that it shows that a majority of doctors oppose the Bill.
	There has been some flourishing of figures in the debate relating to support for and opposition to the Bill. Let me remind the House that the Select Committee, so ably chaired by the noble and learned Lord, Lord Mackay of Clashfern, stated:
	"It is evident that there is a great deal of sympathy at least for the concept of euthanasia, and it seems likely that the level of sympathy has grown in recent years".
	The committee cited the evidence for its conclusion.
	I am sure we all listened attentively to the noble Lord, Lord Moser, as he helped the House to pick its way through the reliability of survey information on public opinion. He drew on his knowledge and great expertise in the area. I am also aware that since the Select Committee published its report, in August 2005 the Daily Telegraph published the results of a survey which showed that 87 per cent of people thought that those who are terminally ill should have the right to decide when they want to die and to ask for medical assistance to help them. However, it is worth reflecting that the survey evidence also suggests that the views of politicians are moving in the opposite direction. In 1995, 70 per cent of MPs surveyed opposed voluntary euthanasia; by 2004 that opposition had increased to 79 per cent
	This debate has highlighted the strong and often opposing and conflicting views that people have on this issue. I recognise that we have to ask ourselves how to weigh the views of particular groups. There is no easy way to resolve these conflicts and dilemmas. Views differ between professionals, members of the public, and Members of your Lordships' House and the other place. However, one thing is clear: we must continue to listen to the views of the public and of patients, as well as those of interest groups. The Government have a strong public involvement agenda and are fully committed to increasing patient choice. Let me be clear that this extension includes areas such as palliative care and end-of-life care. We have actively sought and will continue to seek the views of the public, people who use those services and, indeed, those who work in the area. That helps to illustrate why it is so important to have an open and wide debate on an issue such as this. There is no simple answer and I reiterate the important role the Government believe that Parliament has in providing a forum for considering issues of this nature, in particular the wisdom and experience that your Lordships' House brings to this difficult area.
	I do not propose to comment in detail on the provisions of the Bill. Other noble Lords have raised many points on which the noble Lord, Lord Joffe, may wish to reflect. My understanding is that he is very willing to contemplate amendment. However, I want to remind the House that taking a neutral position on the Bill is not the same as doing nothing. The Government are of course concerned with the fitness for purpose of any legislation proposed, and it is in this context that I mention a few issues in respect of the Bill's provisions.
	First, the Bill proposes to protect a physician from criminal liability if he or she assists a qualifying patient to die or attempts to do so in accordance with the requirements of the Bill. But it makes no mention of protection from civil liability. Secondly, there is a lack of clarity about how the protection from legal liability relates to different members of the healthcare team, and noble Lords will know that healthcare is essentially now, in many cases, a team effort. Thirdly, there is a lack of clarity about the extent to which there would be any duty on physicians and others to assist a patient's death, even if the qualifying conditions are fulfilled. Finally, some of the terms used in the Bill, in our view, have a very wide—and sometimes subjective—set of definitions.
	Again let me be clear that I make no detailed suggestions about how these points might be addressed. A number of noble Lords have raised issues about the obligations that the Bill would place on the health professionals involved. The Government recognise that these have to be addressed fully in legislation of this kind. Whatever the outcome of the Bill, the Government agree that it is important that no one should be compelled to assist someone to die. Others have mentioned the details of the Bill's conscience clause. We would see an important role for the relevant professional bodies in considering whether the Bill should place any duties on healthcare professionals, with a conscientious addition.
	I agree fully with the important place of palliative care in this debate, which has been highlighted by many noble Lords. I, too, pay tribute to all the staff who work in this area and provide such a splendid service to patients in this country.
	All patients should have access to good symptom control and to appropriate support and counselling. However, I fully acknowledge that, historically, hospice services have been developed in an ad hoc way and that specialist palliative care services have largely been restricted to the care of people with cancer. Those with other conditions have largely been cared for by generalist staff such as GPs, district nurses and hospital staff in non-palliative care wards. As a government we are committed to addressing these discrepancies in access to care and we have made good progress in recent years. A key strand of this activity has been to provide training in the principles of palliative care to generalist staff. This was the focus of our £6 million district nurse programme, in which more than 12,000 nurses and a further 3,000 allied health professionals participated. It is also part of our current £12 million end-of-life care programme.
	We have also taken action to increase the availability of specialist palliative care and support through the investment of an extra £50 million a year. This represents an increase in NHS funding for specialist palliative care of about 40 per cent over 2000 levels. This investment has so far funded a range of activity, including the provision of an additional 44 palliative medicine consultants and 172 clinical nurse specialists.
	A key aspect of palliative care, and one which is central to the discussion here today, is the management of pain. A survey of cancer patients' experiences of pain management undertaken by the National Audit Office in 2004 showed good progress since 2000, with five out of six cancer patients believing that hospital staff had done all they could at all times to relieve pain, while over nine out of 10 felt that they were given enough medication or other help to deal with pain after leaving hospital. Clearly we want this position to keep improving as we continue to implement our commitments.
	Let me reassure the House—I think some doubt has been expressed on this during today's debate—we have made clear in our general election manifesto that we are committed to improving palliative care provision so that all people, regardless of their age or condition, are able to choose where they live and die. To deliver this, we have set out a programme of action on end-of-life care in our recent White Paper Our Health, Our Care, Our Say, and we are developing those services in consultation with key stakeholders.
	Whatever the outcome of the Bill, we will continue to extend palliative care. I do not accept the argument that we and the NHS will be deflected from this path by the passage of the Bill, as some have suggested today. That is simply not the case. I gently say to the noble Lord, Lord Elton, that how we invest in our healthcare now is a bit different from when he was a Minister. We should put his experience in this area in perspective.
	We will continue to develop palliative care and build on the excellent work being done by the Marie Curie Delivering Choice programme, a key focus of which is better co-ordination of services and communication between providers.
	Noble Lords have rightly paid tribute to this country's leading position in palliative care. We want to make it even better; we want to build on the work that we have done and we will continue to do that as rapidly as possible.
	In conclusion, I thank noble Lords for the quality of today's debate. It reinforces the importance of open and continuing debate in considering such difficult ethical issues. Once again, important principles have been discussed with passion and reason in a heartfelt way but, I hope, to a constructive outcome. Many points about the provisions of the Bill have been raised and no doubt the noble Lord, Lord Joffe, has much to think about. I repeat, finally, what I said earlier: the Government will not seek to block the Bill's Second Reading, in accordance with the usual conventions. As I said on a previous occasion, I hope that I have achieved a sufficient degree of inscrutability consistent with the Government's position of neutrality on this issue.

Lord Joffe: My Lords, I am grateful to the noble and learned Lord for that intervention. I notice that the noble Lord, Lord McColl, made a number of announcements. I could make an announcement that the noble Lord, Lord Patel, who was a member of the Select Committee, also supports this Bill, and is sorry that he is unable, because of his international commitments, to come to talk to us. He was part of the majority of the Select Committee that supported the Bill.
	The noble Lord, Lord Hylton, made reference to a survey of which I have never heard before, which quoted all sorts of interesting statistics—very different from all those which had emerged elsewhere. I suggest that the noble Lord show his survey to the noble Lord, Lord Moser, and ask him his opinion of it.
	I must comment on the Church's campaign in relation to this debate. Members of the House have paid such careful attention to the innumerable letters they have received. I draw attention to the fact that in the original Bill many letters were received from people who were terminally ill, or had gone through the experience of loved ones suffering terminal illness, and they all set out very moving details of their experience and their wishes. I am sure many Members of this House will recall those letters. Dignity in Dying, which of course supports this Bill, thought it had presented Peers with a range of letters, and did not want to duplicate that.
	I come back to the role of the Church. Naturally it has every right to campaign against the Bill. The right reverend Prelates who have spoken today did what we would expect from our religious leaders: offered a rational and balanced dissection of the case for the Bill and why they thought it should be opposed. But outside the House we have seen a scaremongering campaign, with anecdotal and inaccurate statements, snappy soundbites such as "duty to die", "care, not kill"—as if anyone who wants assisted dying does not care—and, in the Catholic Times last month, a full-page picture of 24 young children who were killed in Nazi-era medical experiments, with the subtitle, "Warning from the past". In my respectful opinion, that campaign reflects no credit on the Churches. As an admirer of the social and human rights work that the Churches do so well, it saddens me that they could allow such a photograph to be published in their response to a Bill whose purpose is to prevent suffering.
	Reference was made to hate mail. Of course, I expect to get hate mail. The most recent hate mail, which I believe appeared on my computer on Tuesday, was very brief. It contained only three names. The first was Hitler, the second was Saddam Hussein and the third was Lord Joffe. I do not mind that comparison—you take it from where it comes—but what really concerned me was why that person adopted that tone. Was it because they had seen pictures like that of the 24 children murdered by the Nazis? Was it because they had heard prominent Members of this House speak at St Christopher's conference in the same breath as speaking about this Bill, not only about the Holocaust but about genocide in Rwanda? That was most inappropriate conduct.
	Rather than going through my endless list and given that my noble friend Lord Marsh is pointedly looking at his watch, I will make one further point on this aspect of the debate and then deal with the amendment moved by the noble Lord, Lord Carlile. We have brought before this court—

Lord Joffe: I should explain what I mean by tradition—something that has happened consistently since 1998. When 105 Private Member's Bills have gone through the House without a Division being called, that seems to me to be a sort of tradition. I have a letter from the Clerk of the Parliaments, which I have temporarily mislaid, which states that it is very uncommon for it to happen. If it did not happen during the passage of those 105 Bills, it seems a little uncommon that it should happen with this Bill. The previous legislation to which the procedure applied concerned the control of pigs. The House divided on that in 1998. That legislation was not a matter of national importance. With this Bill we have before us a matter of national importance that deserves further consideration.
	Although there are differences between me and the noble and learned Lord, Lord Mackay, on the unanimous recommendation of our committee, I assure your Lordships that, if I had realised when I was asked to vote for that Bill that if I dropped the major area of contention—voluntary euthanasia—this unanimous recommendation would no longer be applicable, I and every other Member who supported the Bill would not have allowed the Bill to go through a committee in which the majority of Members supported the Bill.
	Noble Lords will be relieved to hear that I have only two further points.

Lord Carlile of Berriew: My Lords, at 12 and a half minutes past five on a Friday afternoon, I am sure that your Lordships will forgive me if I do not do what I would otherwise have wished to do. I would very much have enjoyed addressing your Lordships in reply to every speech in this debate, but that would not be appropriate.
	I was taught when I was at school never to be intimidated by what was described at the time as an argumentum ad baculum. The stick of the threat—the baculus of the threat—that this provision will be brought back if it is defeated today intimidates neither me nor anyone of my view not one jot. I urge the House to ignore it.
	I regret that the noble Lord, Lord Joffe, who has given us the opportunity with his usual preparedness and eloquence to have a wonderful debate today, has to an extent misrepresented the views of the Clerk of the Parliaments. I want to set that record straight. I would not have referred to the views of the Clerk of the Parliaments—I would not have considered it proper—had it not been done by someone else. I shall read your Lordships the extract, which is brief, verbatim:
	"Could I make it clear that there is no long established convention that the House does not divide on the Second Reading of Private Members Bills. As I stated in a letter to Lord Williamson of Horton on 17 March: 'There has been a noticeable shift of practice in recent years and divisions on Second Reading, which used to be "not uncommon", are now distinctly unusual.' That remains the position. It is unusual, but not improper, to vote against the Second Reading provided notice has been given on the order paper".
	That is what I have done, and following this afternoon's debate it will be part of the convention that it is slightly less unusual that there should be a vote against Second Reading.
	I want make one or two comments before I close. No one who has been in this House today will, I suspect, ever forget the speech of the noble Baroness, Lady Symons of Vernham Dean. However, required reading for anyone considering this subject should be the unemotional, measured and informed speech by the noble Lord, Lord MacKenzie of Culkein, a nurse. It informed us all enormously and, when it was made, well into the debate, it took forward the argument by several steps.
	I would counsel your Lordships to beware of public opinion. I was brought up in Burnley, Lancashire. Nelson, a fine place, was pejoratively known in those days as "little Moscow". Sidney Silverman died. He had been the main proponent of the abolition of capital punishment. The noble Lord, Lord Waddington, was elected as Member of Parliament for Nelson and Colne—he later represented another constituency with great distinction and became Home Secretary—as a result of public opinion in Nelson against the abolition of capital punishment in the aftermath of the moors murders. That opinion might not be quite as extreme today, but—with enormous respect to the noble Lord, Lord Moser—I have a strong suspicion that capital punishment is but one of several examples of public opinion which we in this House and Members of another place would never follow, because, as I said at the beginning, they are pillars, not weathercocks, when it comes to dealing with public opinion.
	The essence of this debate has been demonstrated by the noble and learned Lord, Lord Mackay of Clashfern, who chaired the committee whose deliberations have been referred to extensively this afternoon. Surely the question is: is this Bill fit for legislation? Can it be amended to make it a suitable piece of legislation for the laws of this land? I and a number of other people who have spoken in this debate say not. I say to your Lordships that we have reached the point where we should vote on the principle. I sense that this House wishes to vote on the principle, so I respectfully ask this House to agree to my amendment.